Bonner, Leon NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
LEON J BONNER Male
Date of Death Age If Veteran of U.S. Armed Forces,
6/15/2015 81 War or Dates 01-23-1953 01-22-1957
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address DVAMC 113 Holland Avenue Albany, NY 12208
Manner of Death x❑Natural Cause El Accident El Homicide 0 Suicide Fl Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
Julie Phillips MD.
Address
113 Holland Avenue Albany, NY 12208
• Death Certificate Filed District Number Register Number
City, Town or Village Albany 0198 090
El Burial Date Cemetery or Crematory
,ll / ar1, � � ev;cj tJ^^140
. ❑Entombment Address co,'
NCremation
Date I / Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Q Transportation Shipment
by Common Destination
Carrier
0 Disinterment Date Cemetery Address
El
Reinterment Date Cemetery Address
• Permit Issued to — _ Registration Number
Name of Funeral Home GnS or -1 UAc_ra I Ha l.c- -t ey
Address CC
/ 64 er M � 4vc , �r. 1\) 1 _ra 6 Gil_
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described bove as Indic to .
• E.
Date Issued_ 06152015 Registrar of Vital Statistic J Arrington
(si ature)
District Number 0198 Place DVAMC, 113 Holland Avenue, Albany, New York 12208
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition ( W/- Place of Disposition
(address)
(section) (lotnumber) (grave number)
•
• Name of Sexton or Person in harge Premises J"""
Gam' (Pl seprint)
Signature Title I ,,"r'� t
(over)
; DOH-1555(02/2004)
e. 5