Oddy, Peter Thomas It 2
NEW YORK STATE DEPARTMENT OF HEALTH k Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peter Thomas Oddy Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/06/2022 66 Years War or Dates
1,,,, Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address 33 Gregwood Circle, Queensbury Town, New York 12804
p Manner of Death ❑X Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending
W U Circumstances Investigation
W Medical Certifier Name Title
Q Kyle Leonard MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 4
Burial Date Cemetery,Crematory or Facility Name
01/07/2022 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
Date Place Removed
Removal and/or Held
H and/or
CO
Address
0
O. Date Point of
N ❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
El Disinterment
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
E— Remains are Shipped,If Other than Above
Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2022 Registrar of Vital Statistics CarolinexkregarI Bader(ElectronicallySigned)
(signature/
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ Place of Disposition FvsL 4 fIa�
W Date of Disposition ��� 2Z p (address)
W.
a (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premi G 10. �`' shi,,ti
O (piea print) ,�7�
LU Title (4 AI W1`
Signature
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of A' ' A:'t delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# ' `-