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Sheehan, Paul NEW YORK STATE DEPARTMENT OF HEALTH -- ! Vital Records Section Burial - Transit Permit Name First Middle Last Sex Paul Robert Sheehan Male Date of Death Age If Veteran of U.S. Armed Forces, May 5, 2018 76 War or Dates 8 Place of Death Hospital, Institution or City, Town or Village Queensbury Street Address 31 Birch Road C3 Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W Medical Certifier Name Title 0 Glen Anderson, Address 1448 Route 9 South Glens Falls, NY 12803 ;0 Death Certificate Filed District Number Register Number City, Town or Village Queensbury ii, 1 5 R. v' Date Cemetery or Crematory 014 Burial May 8, 2018 Pine View Crematory ❑Entombment Address k ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed z ❑ Removal and/or Held and/or Address F Hold 611 Date Point of a0 Transportation Shipment t by Common Destination 0 Carrier Date Cemetery Address El Disinterment Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom 2 Remains are Shipped, If Other than Above Address IPermission is hereby granted to dispose of the human remains described above as indicated. Date Issued 5-g-101 g Registrar of Vital Statistics 2.0.E-4.. .-V .Kv. QQ o&L.__., (signature) District Number �65 7 Place Q v e efl S hvr Lf I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 05/08/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) w (section) t�( �Jl(lot number),- (grave number) 0 Name of Sexton or Person in Charge of P mises �.fr(please print)L I Signature Title t11tiL (over) DOH-1555 (02/2004)