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Ogden, Charles Lewis NEWYORKSTATEDEPARTMENTOFHEALTH LF /an Bureau of Vital Records - Burial - Transit Permit Name First Middle Last Sex Charles Lewis Ogden Male Date of Death Age If Veteran of U.S.Armed Forces, 12/09/2023 81 Years War or Dates p. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p• Manner of Death El Natural Cause Accident Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Melody Long PA Address 100 Park Street,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 581 Burial Date Cemetery,Crematory or Facility Name 12/13/2023 Pine View Crematory Entombment Address ©Cremation Queensbury,New York DDonation 0❑Removal Date Place Removed and/or and/or Held pN Hold Address 0 Q. Date Point of CO Transportation Shipment a by Common Carrier Destination O Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/13/2023 Registrar of Vital Statistics Megan Wolin(ECectronicallySigned) (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: W Date of Disposition i21 K{173 Place of Disposition 4 jr q CPmftritI -, 2 (address) W N EC (section) (lot number) (grave number) if g Name of Sexton or Person in Charge of Premis s l on. (please print) W Si nature Y Title / �t�4 g DOH-1555(07/18)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# ,