Hadley, Leah 133
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leah G. Hadley j Female
Date of Death Age ! If Veteran of U.S. Armed Forces,
March 5, 2012 89 ! War or Dates
Place of Death I Hospital, Institution or
Z City, Town or Village Glens Falls , Street Address Glens Falls Hospital
pManner of Death X Natural Cause I I Accident I I Homicide Suicide Undetermined Pending
0 Circumstances Investigation
w Medical Certifier Name Title
Michael Adams Dr.
Address
1448 Route 9, South Glens Falls,NY 12803
Death Certificate Filed ! District Number I Register Number
City, Town or Village Glens Falls,NY 5601 t 05
❑Burial Date ! Cemetery or Crematory
El Entombment March 9, 2012 Pine View Crematorium
Address
❑x Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
-' Hold
N
0 —
Date Point of
NTransportation Shipment
p by Common Destination
Carrier
H Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 01596
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
GEER
2 Address
Ce
w
CI-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 3)7/ /z Registrar of Vital Statistics w QA..Ai .
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ui W Date of Disposition Audi i tat Place of Disposition R14 Uwv, ipn4,�
(address)
W
CO
Ce (section) (lot number) c (grave number)
QName of Sexton or Per on in Charge f Premises f Lc. (please print)
SignatureAIL Title W{�}�►�
r
(over)
DOH-1555(02/2004)