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Kelleher, Sean Michael ICF) NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sean Michael Kelleher Male Date of Death Age It Veteran ot U.S.Armed Forces, 03/15/2022 53 Years War or Dates 1` Place ot Death Hospital,Institution or W City,down or Village Albany Street Address Albany Medical Center Hospital © Manner of Death pi Natural Cause Accident Homicide nSuicide nLJndetennined ❑Pending W ' !Circumstances Investigation W Medical Certifier Name title Michael Farrell MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number City,town or Village 0101 0688 ElBurial Date Cemetery,Crematory or Facility Name 03/25/2022 Pine View Crematorium IlEntonrbment Address nCremation Oueensbury Town,New York nDonatiorr © Rernoval Dale Place Removed and/or and/or Held Hold Address N 0 a. Date Point of U)nTransportation by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67.Hudson Falls,New York 12839 Name of Funeral Finn Making Disposition or to Whom Remains are Shipped,It Other than Above "t Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/18/2022 Registrar of Vital Statistics Daffielk 5C spr. .ifEkrtr'oaual1:yi (s n,tlm:el District Number 0101 Place City Of Albany I certity that the remains of the decedent identified above were disposed of in accordance with this permit/orr: W Date of Disposition 3^ZS-Zp7 Place of Disposition 2Ia.QV? Z'G, / 2 fvd re : W CC U) (se<L'bnl (lot nu nib el) ({rove number/ SName of Sexton or Person i r Charge of Premises w l 6e.444 Z r (pte eee prim') W Signature title Lre_ i DOH-1555(07i181 pi of 2 Public Health Law Sec. 4145(2b) b �� Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#