Loading...
Olcott, Douglas Wilbur ~ T 1.0F tr (31. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas Wilbur Olcott Male Date of Death Age If Veteran of U.S.Armed Forces, 02/03/2024 55 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 54 Riverside Drive,Chester Town Warren, New York 12817 p Manner of Death Natural Cause Accident Homicide Suicide Undetermined ❑X Pending Circumstances Investigation W Medical Certifier Name Title C Lynn Keil PA Address 1340 State Route 9,Lake George Town,New York 12845 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 6 Burial Date Cemetery,Crematory or Facility Name 02/07/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held H Hold Address 0 d Date Point of (/) Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg, New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2024 Registrar of Vital Statistics Mindy Conway(ECectronica((y Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 2 I1 17y Place of Disposition Pa- �u�., (04,m �Vt17 -- 2 (address) Ui CC CC (section) tot number) (grave number) Name of Sexton or Person in Charge of P ises lea print) W Signature Title l °n�PR 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#