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Seanor, Harry Carl
NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Per i Name First Middle Last Sex Harry Carl Seanor Male Date of Death Age If Veteran of U.S.Armed Forces, 06/09/2021 80 Years War or Dates 1958-1983 H Place of Death Hospital,Institution or WCity,Town or Village Jackson Town Street Address 3463 State Route 22, Jackson Town, New York 12865 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation U W Medical Certifier Name Title Barney Rubenstein MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Salem 5761 5 ❑Burial Date Cemetery,Crematory or Facility Name 06/15/2021 Pine View Crematory ❑Entombment Address EDCremation Queensb_ury Town, New York ❑Donation ZO ❑Removal Date Place Removed and/or and/or Held Hold Address 0 0- Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address El Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle, New York 12809 Name of Funeral Firm Making Disposition or to Whom E— Remains are Shipped,If Other than Above Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/14/2021 Registrar of Vital Statistics 7featherA Greenawalt(Electronically Signed) (signature) District Number 5761 Place Salem, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition Jit�,'1 Place of Disposition µ r+'tor,_... _I (address) W Cl) CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Pre ses C P)tL Z /� (please print1111 ,.�� W Signature Title C' �"►tlIA DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) 01 4 8.8 Receipt Human remains of - delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#