Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Leombruni Jr., Donato
4 �10 NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donato Leombruni Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/06/2019 83 Years War or Dates 1958-1960 Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 5 LaClaire Street,Hudson Falls Village, New York 12839 p Manner of Death © Natural Cause Accident Homicide Suicide ❑Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title Elaine Williams NP Address 325 Main Street,Hudson Falls,New York 12839 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 21 Burial Date Cemetery,Crematory or Facility Name 11/08/2019 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation z Removal Date Place Removed and/or and/or Held ~N Hold Address O d Date Point of N ❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Stpo Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address IIE W 91 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/08/2019 Registrar of Vital Statistics CynthiaABard'n(ECectronicaCCySiyned) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z t!V Date of Disposition 1 �`1�l Place of Disposition (address/ W N (section/ (lot numbe (grave number) 0 Name of Sexton or Person in Charge of Premises t �"" please print) LLJ Signature Title IU mpt Ton' DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) w 13 OS 5 Receipt Human remains of .i .! i l . _ 1 delivered on ,�� , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# ; '