Sheehan, Stephen Paul 4
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NEWYORKSTATE DEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Stephen Paul Sheehan Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/11/2022 73 Years Waror Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 26 Meldon Circle,Queensbury Town,New York 12804
E Mannerof Death 0 Natural Cause DAccident Homicide DSuicide ❑Undetermined ❑Pending
VCircumstances Investigation
W Medical Certifier Name Title
0
Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town ofQy District Number Register Number
City,Town or Village 5657 150
Burial Date Cemetery,Crematory or Facility Name
10/13/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
(T❑Removal Date Place Removed
oand/or and/or Held
pN Hold Address
0
0- Date Point of
fA Dransportation
p by Common Shipment
Carrier Destination
disinterment
Date Cemetery Address
Date Cemetery Address
0 Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kikner Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
"S Address
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Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/12/2022 Registrar of Vital Statistics CasnCtxs.?fiStegarrfsrBadergistmnrca*Srgra4
(signature/
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
6 Date of Disposition /0 I i'- (7Z Place of Disposition --Z. L,., el
W
a (address)
LU
N
CC g , .iiot
(section) mber) (grave number)
0 Name of Sexton or Person in Charge o remises
n
Z 11ease print ro/Ait C{7i�/1h l
Signature Title it
DOH-1555 07/18)p l of 2
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Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
P,ijJe View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg. or License#