Sieling, Clelia NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
:-. Name First Middle Last Sex
•r: Clelia Sieling Female
ti Date of Death Age If Veteran of U.S. Armed Forces,
September 3, 2015 74 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address
ti Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
.,., J. Stratton Dr.
Address
: :; 14 Manor Dr.,Queensbury,NY 12804
1: Death Certificate Filed District Number Rggis, te{Number
$ City, Town or Village Queensbury 5657
..,❑Burial Date Cemetery or Crematory
September 8, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
! Hold
O Date Point of
cnTransportation Shipment
Q by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
i:i:;, Permit Issued to Registration Number
:;:; Name of Funeral Home Griswold Funeral Home 00694
s;r Address
*: 1867 State Street, Schenectady, NY 12304
sName of Funeral Firm Making Disposition or to Whom
i,; Remains are Shipped, If Other than Above
Address
lg
▪ Permission is hereby granted to dispose of the human emains described ove as indicated.
:.:▪ .5 'Date Issued l l i' Registrar of Vital Statistics C----_ Q
,C4, (signature)
0..: District Number Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 9-'- IS Place of Disposition 96.1 , u .e w Cr:,mt,t cti-.'Li 0.1
W (address)
a!)
Ce (section) lot number) (grave number)
0 Name of Sexton or Person in Charge of Premises t m o-t< „�i41t
Z
W
Signature A 7 (please print)
Title Cr'e i-c,t`/ vOccf•
(over)
DOH-1555(02/2004)