Seidel, Andrew Paul IF q
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Andrew Paul Seidel Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/30/2019 90 Years War or Dates 1948-1950
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death Undetermined Pending
0 ®Natural Cause Accident Homicide Suicide
W Circumstances Investigation
U
W Medical Certifier Name Title
93 William Cleaver MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 565
Burial Date Cemetery,Crematory or Facility Name
01/04/2020 Pine View Crematory
Entombment Address
®Cremation Queensbury Town,New York
Donation
OZ Removal Date Place Removed
and/or and/or Held
H N Hold Address
O
d Date Point of
to Transportation Shipment
Q by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Q
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/31/2019 Registrar of Vital Statistics `4i96ertA-drew Curtis(`ECect'ronicaflysign
(signature)
District Number 5601 Place Glens Falls, New York
1 certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /Y Z,07 Place of Disposition e r
LU
LU (addres
W
N tsecypn) //ot nu beO (grave number)
cc
0 Name of Sexton or Person in C rge of P ses F"
(please print)
tL Signature S Title
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) - j 3`c
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#