Seaver, Helena NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
iiiiiiiiii
Name First Middle Last - . Sex
Helena G Seaver female
Date of Death Age If Veteran of U.S. Armed Forces,
igin September 10, 1997 71 War or Dates no
Place of Death Hospital, Institution or
• •g City, Town or VillageCity of Glens Falls Street Address Glens Falls Hospital
Manner of Death LAI-71 Natural Cause 0 Accident El Homicide El Suicide ri Undetermined IT Pending
Circumstances Investigation •
tu Medical Certifier Name Title
#1 Michael Castro MD
Address •
102 Park Street, Glens Falls, NY 12R01
Death Certificate Filed District Number Register Number •
iiiii City, Town or Village City of Glens Falls 5 4.4/ /f.6
Date Cemetery or Crematory
Burial September 13, 1997 Pine Viw Cemetery
Address
:::: LICremation 53 Quaker Road, Queensbury, NY 12804
FDate Place Removed
O❑Removal and/or Held
••• and/or iiTi Address
,17 Hold
Q Date Point of •
NQ Transportation Shipment
5 by Common Destination
Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number •
iE Name of Funeral Home Regan and Denny Funeral Service, Inc. 01565
iii>< Address 53 Quaker Road, Queensbury, NY 12804
''>'' Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped, If Other than Above
Address
• M
x
i; Permission is hereby granted to dispose of the human remains scribed ab ye as • dicated.
Date Issued V/ q 7 Registrar of Vital StatisticsAerit `
iiiii (signature)/
IR District Number i O/ Place �/Pi✓.s ,//s, AC,Y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
•
uji Date of Disposition 9/1 /q7 Place of Disposition Pine View Cemetery ,Oueensbury ,NY
2. • (address)
N
. Unad1lla Ext . 14-A 2
IX (section) (lot number) (grave number)
GName of Se Person in Charge of Premises Rodney G. Mosher
g (please print)
. Signatur ko Title Superintendent
DOH-1555 (10/89) p. 1 of 2 VS-61