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West, Leon
NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Leon Warner West I Male Date of Death Age If Veteran of U.S. Armed Forces, 10/23/2019 95 Years War or Dates 1943-1946 Place of Death Hospital, Institution or City, Town or Village Moreau Town Street Address 12 Washington Road, Moreau Town, New York 12803 p Mannerof Death © Natural Cause Accident Homicide ❑ Suicide ❑ Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title David Cunningham MD Address 3 Irongate Center, Glens Falls, New York 12801 Death Certificate Filed District Number Register Number City, Town orVillage Moreau 4562 51 © Burial Date Cemetery, Crematory or Facility Name Entombment 10/28/2019 Pine View Cemetery Address Cremation Queensbury, New York ❑ Donation Z ❑ Removal Date Place Removed O and/or Held F- and/or Hold Address m O IL Date Point of N p ❑ Transportation Shipment by Common Carrier Destination Disinterment Date Cemetery Address ❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd, Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Otherthan Above Address Q W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/25/2019 Registrar of Vital Statistics Geeann 9Yc ca6e (ECectronicaCCySigned) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition 10/28/2019 Place of Disposition Pine View Cemetery LU 22 (address) W Abenaki 12-C 2 rN (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises Connie L . Goedert (Pleaseprint) W Cemetery Superintendent Signature Title DOH-1555 (07/18) p 1 of 2 Public Health Law Sec. 4145(2b) 010350 Receipt delivered on jo A 20 19 an remains of Pine View "tery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License #