Seeholzer, Berthold NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Berthold Seeholzer Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/14/2020 94 Years War or Dates 1942-1946
il— Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address 100 Park Street,Glens Falls,New York 12801
W Manner of Death ®Natural Cause Accident Homicide Suicide Undetermined Pending
U Circumstances Investigation
0 Medical Certifier Name Title
Wendy Steinhacker PA
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed I District Number Register Number
City,Town or Viitage Glens Falls 5601 35
❑Burial Date Cemetery,Crematory or Facility Name
01/17/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or and/or Held
�- Hold Address
N
O
O. Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
F- Remains are Shipped,If Other than Above
Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/17/2020 Registrar of Vital Statistics Wpfiert-4ndrew Curtis(E(ectronicaCCySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
WDate of Disposition Place of Disposition ;At &d C
LU (addres
W
N (section) (lot number) (gra ve number)
0 Name of Sexton or Person in Char of Premises ►�►4 i
Z (please print)
LLJ
Signature S Title d
DOH-1555(07/18)p t 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# ' '