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Olden, Debra Lynn
421 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Debra Lynn Olden Female Date of Death Age If Veteran of U.S.Armed Forces, 01/07/2022 65 Years War or Dates f.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death ©Natural Cause El Accident ❑Homicide El Suicide Undetermined El Pending Circumstances Investigation ElWMedical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 15 ElBurial Date Cemetery,Crematory or Facility Name 01/10/2022 Pine View Crematorium IDEntombment Address 0 Cremation Queensbury Town,New York Donation 0 a Removal Date Place Removed and/or and/or Held F Hold Address 0 �- Date Point of 0 ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom i— Remains are Shipped,If Other than Above 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/10/2022 Registrar of Vital Statistics .9Kegan No6n(ECectronicaQy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: �l • Date of Disposition I/(O I ZZ Place of Disposition .Vi,,,.. t t-Or,u� 2 (address) W CC (section) tot number) (grave number) Name of Sexton or Person in Charge of Premi es f l cEA n`ti Z (please id) W Signature Title 6 XM i1�e_ DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of ... '`b delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#