Webb, Leroy s)
NEW YORK STATE DEPARTMENT OF HEALTH -# 531
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leroy Webb Male
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 25 / 2016 85 War or Dates
iiii Place of Death Hospital, Institution or
City,Town or Village Saratoga Springs Street Address Saratoga Hospital
liti0 Manner of Death L Natural Cause El Accident 0 Homicide1=1 Suicide El Undetermined 0 Pending
W. Circumstances Investigation
Ili Medical Certifier Name Title
a Rodney L. Ying MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number r 5 Registerlyun er
City, Town or Village Saratoga Springs
Burial Date Cemetery or Crematory '
05 / 01 / 2016 Pine View Crematory
';EIEntombment Address
ECremation Queensbury, NY
Date Place Removed
Z❑Removal and/or Held
4 and/or Address
'" Hold
0 Date Point of
4
Transportation Shipment
2-1 by Common Destination
Ei Carrier
iiipLi Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
` Permit Issued to ' Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
>03 402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
CC
lir
04
Permission is he by gr nited to dispose of the human remai e ri aba - dicated
Date Issued '1 �. J�Registrar of Vital Statistics
(signature)
Mi District Number Place Saratoga Springs , New York
iiil
I certify that the remaims of the decedent identified above were disposed of in accordance with this permit on:
Z t�
lu Date of Disposition $/( `/b Place of Disposition & )iE1/4/ (10,4 i,,.,,
(address)
tti
CO
CC (section) 'pot number) r (grave number)
g Name of Sexton or Person in Charge f Premises hf 4e�.k(
Z (pl se print
:.:,..:::,f Signature v'[ Title
(over)
DOH-1555 (02/2004)