Edmonds, Leonard -r , -
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section-- Burial - Transit Permit
Name First Middle Last Sex
Leonard A. Edmonds Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 18,2015 78 War or Dates
Place of Death Hospital, Institutiorlitirondack Tri-County Health Care
Z. City, Town or Village Johnsburg Street Address Center
aManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
. Circumstances Investigation
us Medical Certifier Name Title
0' Tom Warrington
Address
North Creek Health Center,North Creek,NY 12853
Death Certificate Filed District Number Regist r Number
City, Town or Village Johnsburg 5655
❑Burial I Date Cemetery or Crematory
ElDecember 22, 2015 Pine View Crematory
Entombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
Cl)
0 Date Point of
O.
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
;} Remains are Shipped, If Other than Above
Address
Permission is herebygranted to dispose of the human r 'ns de ribe bove s in i ed.
ep 1
Date Issued 1,3+4)1' I S Registrar of Vital Statistics (D
(signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 1'Z'Z'/45— Place of Disposition ) i) t 'Q& Ccerru,,I ,y
W (address) /
Cl)
IX
0 (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises .- t.--/,a.yr ( rz ci,e
Z (please print)
W Signature Title
(over)
DOH-1555 (02/2004)