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Seitz, Gloria Ann . ©NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Gloria Ann Seitz Female Date of Death i Age If Veteran of U.S.Armed Forces, 08/21/2022 93 Years I War or Dates F.. Place of Death Hospital,Institution or WCity,Town or Village Chester Town Warren Street Address 12 Frederick Road,Chester Town Warren,New York 12817 p Manner of Death El Natural Cause aAccident Homicide Suicide Undetermined El ❑Pending V Circumstances Investigation WQ Medical Certifier Name Title Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 11 Burial Date Cemetery,Crematory or Facility Name v 08/22/2022 Pine View Crematorium Entombment Address 0Cremation Queensbury Town,New York Donation Q{-_-_}Removal Date Place Removed I` and/or and/or Held CO Hold Address 0 d Date Point of U)❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address EiReinterment 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 H Remains are Shipped,If Other than Above ',g Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/21/2022 Registrar of Vital Statistics Windy Conway(`E1 ctronicalCySigned) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— p� W Date of Disposition O r?/)-02.y_ Place of Disposition ®jr G (ACM) t ,,,,yra Q r P (address) W co (section) (lot number) (grave number) g Name of Sexton or Pe n in Charge of Premises LPm t')' Jcu;TA.,< (please print) W Signature Title 0011-1555 OiI181 a 10 2 Public Health Law Sec. 4145(2b) Receipt 3 Human remains of -- delivered on , 20 .... 1{ F 1 1 .7 , Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#