Gaynor, Leonard Y' 3 4
, 6ffo
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leonard Gaynor Male
Date of Death Age If Veteran of U.S. Armed Forces,
08 29 / 2016 72 War or Dates N/A
14 Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs, NY Street Address 160 Leonard Ave. Apt 11
QManner of Death®Natural Cause 0 Accident 0 Homicide 0 Suicide 7Undetermined El Pending
lii Circumstances Investigation
t Medical Certifier Name Title
a Vincent Meyer MD
Address 418 Geyser Rd # 14, Ballston Spa, NY
Death Certificate Filed District Number I Register ,gpber
City, Town or Village Saratoga Springs, NY c5C�
"Burial Date Cemetery or Crematory
08 / 30 / 2016 Pine View Crematory
's Entombment Address
Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
Z Removal and/or Held
❑and/or Address
Hold
0
10 Date Point of
tt Transportation Shipment
ES by Common Destination
Carrier
0 Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Ai Name of Funeral Home Compassionate Funeral Care I 00364
tik Address
402 Maple Ave. Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
111
Permission is hereby ranted to dispose of the human rem "dPscri d abe indicate
Date Issued 8 � /Co Registrar of Vital Statistics 1 F
(signature)
II:i;i:: District Number 115L 1 Place Saratoga Springs, NY , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Iti awl...,
gagi.4—.Date of Disposition �13t/f,6 Place of Disposition
N (address)
ta
cc (section) (lot nu er) (grave number)
IIName of Sexton or Person in Charge of Premises ►,it.&'
z (please print)n1n
Signature Title CRAE M41 mil`.
(over)
DOH-1555 (02/2004)