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Seefeldt, Nelle Anna NEW YORK STATE DEPARTMENT OF HEALTH: -7 ii.it 13? It t3 e Vital Records Section Burial --Transit Permit Name First Middle Last Sex Nelle Anna Seefeldt Female • Date of Death Age If Veteran of U.S. Armed Forces, March 6,2012 87 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital e Manner of Death ICI Natural Cause I I Accident I I Homicide Suicide ( 1 Undetermined r I Pending tit Circumstances Investigation Medical Certifier Name 0 D., S Title 0 im Ct.h-6I a..„i - M . . e' t co Address ePG a;3 Death Certificate Filed District Number Register Number '3 City, Town or Village Glens Falls 5601 ) 1 5 ❑Burial Date Cemetery or Crematory ❑Entombment March 8, 2012 Pine View Crematorium Address ©Cremation 21Quaker Road, Queensbury, NY 12804 Date Place Removed Z I Removal and/or Held O and/or Address F' Hold to O Date Point of N I I Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address I I Reinterment Date Cemetery Address #; Permit Issued to Registration Number °, Name of Funeral Home Regan& Denny Funeral Home 01443 • Address 53 Quaker Road,Queensbury,NY 12804 r Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above 5, Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 3Jc l/Z Registrar of Vital Statistics (/)O.t �,,-.�_b w 0 ''" (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed f in accordance with this permit on: W Date of Disposition WA it k 10t Place of Disposition N,Utr4.J Crtm.,tpr„` 2 W (address) N Qre (section) _ (ot number) (grave number) Name of Sexton or Person in Charg of Premises i r,s r- th►1{�}- Wplease print) Signature ` - Title Cil1riTi-44 (over) DOH-1555(02/2004)