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Morgan, Leonard \ '.--71111141.1 NEW YORK STATE DEPARTMENT OF HEALT "- fie)rkiit Vital Records SectionBurial - Transit Name First Middle Last Sex Leonard A. Morgan Male Date of Death Age If Veteran of U.S. Armed Forces, June 27, 2013 57 War or Dates Place of Death Hospital, Institution or Town or Village Glens Falls Street Address Glens Falls Hospital p anner of Death n Natural Cause E Accident n Homicide n Suicide n Undetermined Pending t Circumstances Investigation Z Medical Certifier,-, Name Title 44 0 cY t\\e.� ��;) � 5 res ,r Death Certificate Filed n�\ S^ District Number Register Number City, Town or Village Glens Falls,NY 5601 2' 7 ❑Burial Date Cemetery or Crematory ❑Entombment July 5, 2013 Pine View Crematory Address ©Cremation Quaker Road,Queensbury,NY 12804 Date Place Removed ZO n Removal and/or Held and/or Address t"' Hold N O Date Point of N pi Transportation Shipment p by Common Destination Carrier n Disinterment Date Cemetery Address E Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Road, Queensbury, NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address `A'' Permission is hereby granted to dispose of the human remains described above as indicated. € Date Issued "7/ 1 / 13 Registrar of Vital Statistics ( nature) 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 LIJ Date of Disposition 7-114(3 Place of Disposition at kb,. t� (address) re (section) (lot ber) p Name of Sexton or Person in Charge of remises (grave number) r 14 W (p print) Signature Title I :. IL 'it v ( (over) DOH-1555(02/2004)