Leach, Julie Ann IL
NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Julie Ann Leach Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/01/2020 82 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Saratoga Springs Street Address 390 Church Street, Saratoga Springs, New York 12866
Uj
p Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
U Title
ILI Medical Certifier Name
C) Paul Heasley MD
Address
445 New Kamer Road,Albany,New York 12205
Death Certificate Filed District Number Register Number
City,Town orViUage Saratoga Springs 4501 10
❑Burial Date Cemetery,Crematory or Facility Name
01/06/2020 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
Donation
Z ❑Removal Date Place Removed
0 and/or and/or Held
P Hold Address
N
aDate Point of
N ❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury, New York 12804
Name of Funeral Firm Making Disposition or to Whom
F— Remains are Shipped,If Other than Above
Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/06/2020 Registrar of Vital Statistics ,ynlrn PaulFranck(Ekctronicaf Signed
(signature)
District Number 4501 Place Saratoga Springs, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: `
f—
Z Date of Disposition 6 Place of Disposition t�
W (address)
2
W
Q (sedionJ (rot number) (grave number)
o Name of Sexton or Person in Charge of P e ises
� ease grin
Z '
W Signature Title
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01321.0
Receipt
Human remains of r delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#� k`