Turley, Leo NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leo Richard Turley Male
z Date of Death Age If Veteran of U.S. Armed Forces,
12/7/2018 91 War or Dates Marines
Place of Death Hospital, Institution or
City, Town or Village Queensbury,NY Street Address 3 Bayberry Court
Manner of Death E Natural Cause [Accident J Homicide [Suicide n Undetermined C Pending
Circumstances Investigation
Medical Certifier Name Title
Mary Stein,MD
Address
,, Queensbury,NY
Death Certificate Filed District Number R gier Number
City, Town or Village Queensbury,NY _ 5657
❑Burial Date Cemetery or Crematory
El Entombment December 10, 2018 Pine View Crematorium
Address
®Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
Z El Removal and/or Held
2and/or Address
I Hold
(.0
0 Date Point of
N ! !Transportation Shipment
p by Common Destination
Carrier
n Disinterment Date Cemetery Address
Date CemeteryAddress
(Renterment
y Permit Issued to Registration Number
71-1 Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains descried above as indicated.
Date Issued 0-) O tiegistrar of Vital Statistics, R ....---
(signature)
District Number 5657 Place Town of Queensbury,NY
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ILI Date of Disposition ) -)/-/s' Place of Disposition pi i1e., 146)41 cif epncd-cry
W (address)
Cl)
0 (section) (lot number) (grave number)
ZName of Sexton or Person in Charge of Premises J e6p .y SQu.ct-s
ILI
Z (please print)
Signature /� � Title L Tt, cii-c, F
(over)
DOH-1555(02/2004)