Loading...
Urschel, Leonard # , '7/ 2. NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Leonard Frank Urschel Male D• ate of Death Age If Veteran of U.S. Armed Forces, r September 28, 2016 94 War or Dates .1,,; Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital M• anner of Death LLtdm7 Natural Cause Accident n Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title i Address Death Certificate Filed District Number Register Number Jr^ va � City, Town or Village Glens Falls, NY 5601 ❑Burial Date Cemetery or Crematory September 30, 2016 Pine View Crematorium CI Entombment Address ®Cremation 51 Quaker Road,Queensbury,NY 12804 Date Place Removed ZG ❑Removal and/or Held and/or Address E Hold CO O Date Point of N ❑Transportation Shipment p by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address P• ermit Issued to Registration Number 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 IAddress Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 9 / 30 1 l6 Registrar of Vital Statistics l.,1/4.4 (signature District Number 5 6©1 Place 6 (Q'S� k,5, (Ai U I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition (b r13in. Place of Disposition ?nAlt.-)-J C{rm�cllpf► ,W (address) Cl) et (section) (lot nu r) (grave number) pName of Sexton or Person in Charge of Premises iti-itykr 3 mil lit Z �1 1 (please print) W ji Signature L..0 Title IA (over) DOH-1555(02/2004)