O'Dell, Allen Gerald Jr. .40
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NEW
DEPARTMENT OFHEALTH Burial - Transit Permit
Bureau of Vital Records
es
Name First Middle Last Sex
Allen Gerald O'Dell Jr. t Male
Date of Death Age If Veteran of U.S.Armed Forces,
04/21/2022 83 Years War or Dates 1955-1958
(,,, Place of Death Hospital,Institution or
Z City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing
igManner of Death El Natural Cause ❑Accident Homicide ❑Suicide ❑ ❑
Undetermined Pending
Ili
Circumstances Investigation
G Medical Certifier Name Title
Shardul Koppar DO
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed Village Of Granville District Number I Register Number
City,Town or Village 5725 15
Burial Date Cemetery,Crematory or Facility Name ~
04/22/2022 Pine View Crematoirum
Entombment Address
Cremation Queensbury Town,New York
Donation
ViRemoval Date Place Removed
and/or and/or Held
to Hold Address
4 Transportation Date Point of
a by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
pReinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Fails,New York 12839
Name of Funeral Firm Making Disposition or to Whom
I- Remains are Shipped,If Otherthan Above
3 Address
CC
12
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 04/22/2022 Registrar of Vital Statistics iardogerts(E4ctrnnu:JQSnr)
(signature)
District Number 5725 Place Village Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition -�3 Place of Disposition vie VI!e f-
2 (address)
IW
fA
fr (section) (lot umbe (gra 6e number/
8 Name of Sexton or Person in Charg Pre ' es lfsnia✓fn liOv�
z � � (please print)
iW Signature 1 j Title fft'li
DOH 1555(07/18)p 1 of 2 /' I
9S
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#