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O'Keefe, Daniel John Sr.
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Daniel John O'Keefe Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 02/04/2024 68 Years War or Dates i_ Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 466 Luzerne Road,Queensbury Town, New York 12804 p Manner of Death El Natural Cause Accident ❑Homicide OSuicide riUndetermined ❑Pending W C.) Circumstances Investigation W Medical Certifier Name Title 0 Eugene Merecki MD Address 6 Medical Park Drive,Malta Town,New York 12020 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 24 Burial Date Cemetery,Crematory or Facility Name 02/06/2024 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Date Place Removed ❑Removal and/or Held H and/or N Hold Address 0 d Date Point of U)❑Transportation Shipment Q by Common Carrier Destination O Disinterment Date Cemetery Address Date Cemetery Address 0 Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer 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 i Address re W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/06/2024 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (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: I- W Date of Disposition Z 11 1 ZH Place of Disposition Tom/+CJ ( I11A'�aZ4 (address) W N (section) (!ot number/ (grave number) Q �1 8 Name of Sexton or Person in Charge of Premises d ' '1: _ .or Z ✓J <'s - `IPleaseprim) W Signature //�/"<� Title (��' �� DOH-1555(07/18)p 1 of 2 I / S � t w. .J 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#