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Leppert, John William 36� NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John William Leppert Male Date of Death Age If Veteran of U.S.Armed Forces, 04/20/2020 92 Years War or Dates US Navy F. Place of Death Hospital,Institution or WCity,Town or Village Kingsbury Town Street Address 31 County Route 41,Kingsbury Town,New York 12839 p Mannerof Death ©Natural Cause Accident Homicide Suicide El UndeterminedEl Pending Circumstances Investigation W Medical Certifier Name Title Scott Miller PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Kingsbury Town 5762 12 Burial Date Cemetery,Crematory or Facility Name 04/21/2020 Pine View Crematory Entombment Address Cremation Queensbury,New York Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N O d. Date Point of U) ❑Transportation Shipment p 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 Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/20/2020 Registrar of Vital Statistics Cynthia Bard'n(ECectronically Signed) (signature) District Number 5762 Place Kingsbury Town, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition '/•-Z)-Z02d Place of Disposition f�QtJ L�wJ e '/'t"1 4y! W (addre ) 2 W N (sedan) (lot umber) (grave number) Q SName of Sexton or Per a f Premises l t ✓t �'Iry'l z (please print) IL Signature Title C Joe DOH-1555(07/18)p I of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on T , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#