Duell, Leon NEW Y'bRK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leon "Pudgie" Duel! Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 4, 2012 80 War or Dates
Place of Death Hospital, Institution or
- City, Town or Village Glens Falls Street Address Glens Falls Hospital
g Manner of Death Natural Cause E Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
James North, M.D. Dr.
Vie.
Address
„. Broad Street Glens Fall's 12801
- Death Certificate Filed � District Number Register Number
r City, Town or Village �'7•%Go r /57 //�-S ,j�Co0l /,57
�
Date Cemetery®Burial or Crematory
April 9, 2012 West Glens Falls Cemetery
❑Entombment Address
❑Cremation Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
ElTransportation Shipment
;a; by Common Destination
• Carrier
Disinterment Date Cemetery Address
0 Renterment
Date Cemetery Address
Permit Issued to Registration Number
" Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
k Name of Funeral Firm Making Disposition or to Whom
AY_• Remains are Shipped, If Other than Above
Address
- Permission is hereby granted to dispose of the human remains desc ' e a ve ind�t`
Date Issued �y/c"9`20/2-Registrar of Vital Statistics _
VI 77
(signature)
6 District Number 50/ Place �- ,'i � Ay
titI certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 04/09/2012 Place of Disposition Queensbury,NY 12804
(address)
West G1Pns Falls Cemetery
(section) (lot number) (grave number)
g Michael Genier
Name of Sexton or Person i har a of Premises
(please print)
Signature � ^— Title Superintendent
(over)
DOH-1555 (02/2004)