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Seward, Melissa Mary
010 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Melissa Mary Seward Female Date of Death Age If Veteran of U.S.Armed Forces, 11/16/2021 56 Years War or Dates H Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident ❑ Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 521 ❑Burial Date Cemetery,Crematory or Facility Name 11/19/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation ZO El Removal Date Place Removed and/or and/or Held (75 Hold Address 0 a. 1-1 Date Point of Cl) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Date Cemetery Address El Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address W o. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/19/2021 Registrar of Vital Statistics cNp6ertAndrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition // - 2/ Place of Disposition ,1 e (,:�cc) C t-ti/L1 IJI (ad W (section) (tot umber (grave number) 0 Name of Sexton or Person in Charge o emises/ Vf9DN ` Z � (please print) W Signature / Title DOH-1555(07/18)p t of 2 r . . 3 1.`w 3 5 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#