Seitz, Kathleen NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
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Name First Middle Last Sex
KATHLEEN E. SEITZ Female
Date of Death A e If Veteran of U.S.Armed Forces,
Jun.18,1993 81 War or Dates No
1-.
Place of Death Hospital, Institution or
W CitY MOOMINIC Glens Falls Street Address Glens Falls Hospital
0W Manner of Death 1�1 Natural Cause ❑ Accident Homicide Suicide Undetermined � Pending
�I Circumstances Investigation
Medical Certifier Name Title
O Daniel Way .... M.D.
Address
H.H.H.N., Warrensburg, N.Y.
Death Certificate Filed District Number Register Number
City,X Glens Falls 5601 (3 41/
Date Cemetery or Crematory
❑Burial Jun. 21 , 1993 Pine View Crematory
...Address ..... .::.
x0 Cremation
Queensbury, N.Y.
z Date Place Removed
OI 0 Removal and/or Held
i- and/or Hold ....::..............:.....:: .:
Address
N'
I Date Point of.:.
cn ❑Transportation by Shipment
pi Common Carrier ....... ..:.. .: .:::.:.:. ...:.:... .......
Destination
...... ..................................................................................................................................................................................................................................................................
El Disinterment Date Cemetery Address
...................................................................................................................................................................................................................................................................................
❑ Reinterment Date Cemetery Address
Permit Issued to ' Registration Number
Name of Funeral Firm Alexander—Baker Funeral Herne 00012
...................................................................................................................................................................................................................................................................................
Address
114 Main St., Warrensburg, N.Y. 12885
...................................................................................................................................................................................................................................................................................
Name of Funeral Firm Making Disposition or to Whom
g Remains are Shipped, If Other than Above
�.....Address.....................................................................................................................................................................................................................................................
W.
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Permission is hereby granted to dispose of the hu remain describ above as indicated.
Date Issued 6/21/93 Registrar of Vital Statistics
(signature)
,("72/
District Number 5601 Place City Hall, City of Glens Falls, N.
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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W Date of Disposition/ 4:2Z —13 Place of Disposition /y1 t/2//` &�,,c�/j1I2/(' /2/
2 (address)
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CO (section) (lot number) (grave number)
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O �/51llF27 /�! 5e�4.1 pl Name of Sexton or erson in harge of Premis
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Z (please print) ' Jr
W Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61