Seeley, Katie Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Katie Marie Seeley Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/07/2021 33 Years War or Dates
F. Place of Death Hospital,Institution or
W City,Town or Village Argyle Town Street Address 905 West Valley Road,Argyle Town, New York 12809
Manner of Death El Natural Cause ❑X Accident ❑Homicide I=1 Suicide ❑Undetermined ❑Pending
V Circumstances Investigation
W Medical Certifier Name Title
C/ Robert Lemieux Coroner
Address
415 Lower Main Street,Hudson Falls Village,New York 12839
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 50
❑Burial Date Cemetery,Crematory or Facility Name
08/10/2021 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
EiDonation
cRemoval Date Place Removed
and/or and/or Held
i Hold Address
to
0
0• Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
i— Remains are Shipped,If Other than Above
.E Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/10/2021 Registrar of Vital Statistics SireleyMckernon(ElectronicalijiSignea9
(signature)
District Number 5750 Place Argyle, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
f7ii__.• Date of Disposition g I�( 114 Place of Disposition
-1
2 (address)
W
(section) (lot number) (grave number)
• Name of Sexton or Person in C rgeof Premises l'✓ Al�"►'r.�
Z (plea'sdlprint) O
W Signature Title �1"''' `
DOH-1555(07/18)p 1 of 2
r1 02 /
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20 1
Pine View Cemetery Representing the fUneral home named on burial permit
Official Funeral Directors Reg.or License#