LeBron, Janet NEW YORK STATE DEPARTMENT OF HEALTH • •
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Janet Leone LeBron Female
Date of Death Age If Veteran of U.S. Armed Forces,
11/13/2017 66 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Memorial Hospital
Manner of Death gi Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ri❑Pending
Circumstances Investigation
- Medical Certifier Name Title
Christopher Hessick DO
Address
600 Northern Boulevard,Albany,New York 12204
Death Certificate Filed District Number Register Number
''i' City, Town or Village Albany 0101 2484
❑Burial Date Cemetery or Crematory
11/15/2017 Pine View Crematory
❑Entombment Address
ail®Cremation -Queensbury Town, New York
Date Place Removed
ri❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
• by Common Destination
Carrier
Date Cemetery Address
Disinterment
tht
we
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
rig 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
Remains are Shipped, If Other than Above
Address
gra Permission is hereby granted to dispose of the human remains described above as indicated.
' Date Issued 11/15/2017 Registrar of Vital Statistics Damerres Gaspe FCectrrnricaaySigned-
ii (signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 88 fri O Place of Disposition gu:V,✓ (w*-z1-04.-
(address)
(section) (lo//number) (� (grave number)
- Name of Sexton or Person in Charge of P emises
/�f„ J C1"IIt
please rint)
SignatureZ1 Title eRf nitrVit-
(over)
DOH-1555 (02/2004)