Leinov, Laura r 'II
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Laura Leinov Female
Date of Death Age If Veteran of U.S. Armed Forces,
07 / 11 / 2016 91 War or Dates N/A
- Place of Death Hospital, Institution or
WCity, Town or Village Saratoga Springs Street Address Mary's Haven
ctManner of Death Natural Cause 0 Accident Homicide 0 Suicide 7 Undetermined 0 Pending
Circumstances Investigation
la Medical Certifier Name Title ./
Q Susan M. Muller MD
Address
119 Lawrence St, Saratoga Springs, NY 12866
Death Certificate Filed District Nu sr , Regir N ber
City, Town or Village Saratoga Springs '"7
I:'>i' 0Burial Date Cemetery r crematory
07 / 13 / 2016 Pine View Crematory
'> ElEntombment Address
CCremation Queensbury, NY
Date Place Removed
Z 0 Removal and/or Held
2 and/or Address
t Hold
Ca.{7 Date Point of
Q Transportation Shipment
0 by Common Destination
Carrier
>"Q Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to I Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc 00364
Ni Address
402 Maple Ave., Saratoga Springs, NY 12866
gi Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
Z.
111
Permission is he by anted to dispose of the human re ains s ed alb s indica d.
>, Date Issued ( Registrar of Vital Statistics t
(signature)
`i; District Number U, . bi Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
111 Date of Disposition 1 liti((6 Place of Disposition fi►I-1100,„✓ ayr1Av`ort‘,..
2 (address)
tU
CC (section) (lot number (grave number)
0 Name of Sexton or Person ip Charg of Premises - /61 1 �-r �^'�`�
zct ' (p/ se grin
t Signature Title wI, 'ThIt
(over)
DOH-1555 (02/2004)