Barton, Leon 4 PO
NEW YORK STATE DEPARTMENT OF HEALTH'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leon(Lee) A. Barton Male
Date of Death Age If Veteran of U.S. Armed Forces,
6/15/2018 91 War or Dates
. Place of Death Hospital, Institution or
Z
W City, Town or Village So. Glens Falls Street Address Home Of The Good Shepard
p Manner of Death ! I Natural Cause Accident —Homicide Suicide 1 Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
C Elaine Willaims RNP
Address
325 Main Street,Hudson Falls NY
Death Certificate Filed District ymper, Reje}Number
City, Town or Village ��(([oi �
❑Burial Date Cemetery or Crematory
❑Entombment June 19,2018 Pine View Crematorium
Address
1 Cremation 51 Quaker Road,Queensbury,NY 12804
Date Place Removed
ZZ ❑Removal and/or Held
and/or Address
H Hold
(i)
O Date Point of
W ❑Transportation Shipment
p by Common Destination
Carrier
—
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
_- Remains are Shipped, If Other than Above
2 Address
ft
Permission is hereby granted to dispose of the human rem ' es 'b above as indicated.
Date Issued Qh//ci poi a Registrar of Vital Statistics
(signature)
District Number P\ Place orOAti 4/ oa 1 0 .)-
I certify that the remains of the decedent identified above were dispo ed of in accordance with this permit on:
Z �
UJ lr,,Date of Disposition to 122Ii$ Place of Disposition ?J.- ..0or,..,W (address)
U)
O (section) i(tot number)( (grave number)
p Name of Sexton or Person in Charge of Premises (tr,, J tvotil
�Z ``,' (phase print)
Signature /k.U- Title (nf-inftru2
(over)
DOH-1555(02/2004)