Seeley, William Clifford t 701'
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Clifford Seeley Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/25/2021 70 Years War or Dates
E.. Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address St Peters Hospital
W
p Manner of Death El Natural Cause El Accident El Homicide El Suicide �Undetermined El Pending
W fJ Circumstances Investigation
W Medical Certifier Name Title
0 Brittany Center NP
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2678
0 Burial Date Cemetery,Crematory or Facility Name
10/29/2021 Pine View Crematory
0 Entombment Address
fjCremation Queensbury Town,New York
Donation
iRemoval Date Place Removed
and/or and/or Held
Hold Address
N
0
Q. Date Point of
Cl) Li Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
5 Address
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/29/2021 Registrar of Vital Statistics 7anie&Sciikspie(EYectronicallySigned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IF-
W Date of Disposition ji I i I ti Place of Disposition iru IL
2 (address)
ILLI
N CC (section) A (lot number) r (grave number)
Name of Sexton or Person in Charge of Premises f"+ �. di
Z
(pleait
print)
W Signature Title f r,'' telPh
DOH-1555(07/18)pi of 2
I -
g.a1 ! 274
Public Health Law Sec. 4145(2b)
Receipt
1
1
1 Human remains of delivered on ` 20
1
dr
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#