Seavers, Elsie C 11 719,
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Elsie C.Seavers Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/28/2021 98 Years War or Dates
i— Place of Death Hospital,Institution or
Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek
p Manner of Death NI Natural Cause ❑Accident Homicide 0 Suicide 0 Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
C James Hindson MD
Address
112 Ski Bowl Rd,Johnsburg Town,New York 12853
Death Certificate Filed District Number Register Number
City,Town or Village North Creek 5655 33
ElBurial Date Cemetery,Crematory or Facility Name
08/30/2021 Pine View Crematorium
0 Entombment Address
0 Cremation Queensbury Hamlet,New York
ElDonation
ElRemoval Date Place Removed r
- and/or and/or Held
i- Hold Address #
CO ).
O. Date Point of
N ❑Transportation 0.r
by Common Shipment ES
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
CC
W
I' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/30/2021 Registrar of Vital Statistics Kstt(r(een C.Gorah(ECectronicatySigned)
(signature)
District Number 5655 Place North Creek, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 43131 17I Place of DispositionIILI „r
— etc.. —
2 address)
W
Q (section) � (lot number) (grave number)
SName of Sexton or Person in Charge of P mises fts AA
Z (p/ase print)
W Signature Title (!?Eel"fTr2Yt
.... 2
DOH-1555(07/18)p 1 of 2
e15O94
Public Health Law Sec. 4145(2b)
Receipt
Human remains of ,° e '' ` ' - delivered on , 20"T
s;
Pine View Cemetery Representing the funeral home named on Furi31}hermit
Official Funeral Directors Reg. or License#