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Olson, Nancy Lee NEW YORK STATE DEPARTMENT OF HEALTH . ' Burial Bureau of Vital Records - Transit Permit Name First Middle Last Sex Nancy Lee Olson Female Date of Death Age If Veteran of U.S.Armed Forces, 10/06/2023 82 Years War or Dates F, Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital WW Manner of Death Undetermined Pending Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title CI Julian Marynczak PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 467 ElBurial Date Cemetery,Crematory or Facility Name 10/10/2023 Pine View Crematory Entombmlent Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 0. Date Point of N ElTransportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address ElReinterment 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 F- 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 10/10/2023 Registrar of Vital Statistics Megan.Nofin(ECectronica(Ty Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition OW 11 Place of Disposition Tx u ,i c,., f it c,Ylgrof ,t,;7.N. iii 2 (address) W NCC (section) % (lot number) (grave number) g Name of Sexton or Person in Charge of Premises 11 11C•tfj�iv < s A n Z �'`�� p/ease printr W Signature ( - `��' Title (OwMgl-t;;( DOH-1555(o7/18)p 1 of 2 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# ',' .4