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Comora, Leonore NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section .-_ Burial - Transit Permit ,> Name First Middle Last Sex Leonore I. Comora Female Date of Death Age If Veteran of U.S. Armed Forces, January 21, 2017 86 War or Dates n/a Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address The Pines Of Glens Falls Manner of Death X Natural Cause ❑Accident n Homicide n Suicide n Undetermined Pending Circumstances Investigation Me cal Certifier Name Title �"r 1�)Q- af\ Y`(- �c c\.S - i L�11\ \ MO i Address F f '�3 _\-• cNk,_ 11, Death Certificate Filed- District Number Regis et Number a City, Town or Village Glens Falls, NY 5601 L 1 • ❑Burial Date Cemetery or Crematory January 23,2017 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed Z ❑Removal and/or Held O and/or Address H Hold co 0 Date Point of N ❑Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number >;f Name of Funeral Home Regan Denny Stafford Funeral Home 01443 i Address ;' 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is hereby granted to dispose of the human remains desc ' d bo a . ated. 'r Date Issued 0/ Z3�p/.2 Registrar of Vital Statistics �L (signature) ' District Number" J 4O/ Place City of Glens Falls,NY 12801 � I certify that the remains of the decedent identified above were disposed of in,accordance with this permit on: W Date of Disposition 1116 1 j 1 Place of Disposition 2qe uJ ., (- ci W (address) U) 0 (section) / (lot number)(� (grave number) QName of Sexton or Person in Charge of Premises girt SQ1114' z (l f// ease print) W Signature �� p Title C /ilft�l� (over) DOH-1555(02/2004)