Seeley, Marilyn NEW YORK STATE DEPARTMENT OF HEALTH ,
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Marilyn Grace . - Seeley Female
Date of Death Age If Veteran of U.S. Armed Forces,
09 / 30 / 2018 84 War or Dates N/A
ii4 Place of Death Hospital, Institution or
WCity, Town or Village Malta Street Address Home of the Good Shepherd
4 Manner of Death®Natural Cause;Q Accident 0 Homicide 0 Suicide �Undetermined �Pending
ILICircumstances Investigation
W Medical Certifier Name Title
0 Gail Casals FNP
Address
1 Tallow Wood Drive, Clifton Park, NY 12065
gig Death Certificate Filed District Number Register Number
ir.:. City,Town or Village Malta
`<<0Burial Date Cemetery or Crematory
10 / 03 / 2018 Pine View Crematory
Kg fEntombment Address
iiiii ECremation Queensbury, NY
>..>;_` Date Place Removed
Z❑Removal and/or Held
,...4
and/or Address
` Hold
4;4fl; Date Point of
Transportation Shipment
3 by Common Destination
Carrier
j3 Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
ui
iiigg Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 1 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
> Name of Funeral Firm Making Disposition or to Whom
* Remains are Shipped, If Other than Above
# Address
#C
III
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 5 Registrar of Vital Statistics \'.c_.ojc
(signature)
District Number 4S100 Place Malta , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
14
40 Date of Disposition f0/1111f Place of Disposition ,mu„,.., 4„.(70r...1
(address)
ill
til
Ct (section) (lot mbar) (grave number)
C Name of Sexton or Person in Charge of Premises f n.sipi_ A,,,,,in
�Z (please p nt) •
Signature Lit 4 Titlei171i41iQ.
(over)
DOH-1555 (02/2004)