Griffin, Leonard it 711
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leonard Alden Griffin Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/07/2017 74 Years War or Dates
Place of Death Hospital, Institution or
j City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X❑Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined �Pending
W Circumstances Investigation
MMedical Certifier Name Title
t3 Matthew Loftus PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 520
❑Burial Date Cemetery or Crematory
10/10/2017 Pine View Crematorium
❑Entombment Address
®Cremation14 Queensbury Town, New York
Date Place Removed
7❑Removal and/or Held
and/or Address
F- Hold
10
f.) Date Point of
0❑Transportation Shipment
by Common Destination
Carrier
s
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
'OP Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home Inc 00885
Address
ei., 46 Williams Street,Whitehall Village,New York 12887
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
MOW
- Address
1
W
k Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/10/2017 Registrar of Vital Statistics Men ACurtis E(ectronicaaySigned
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in `
accordance with this permit on:
`LU Date of Disposition IDhho w ) Place of Disposition f 4(,,, -•+.Vfvn,
I (address)
t ; (section) (lot number) (grave number)
CI Name of Sexton or Person in Charge of Premi es t1^,/(blase print)
ir
/1 (P� P )
Signature G� Title `( Oa&
(over)
DOH-1555 (02/2004)