Leslie, Naton e A #t .
NEW YORK STATE DEPARTMENT OF HEALTH Burial - TransitPermit
. Vital Records Section
Name First Middle Last Sex
NATON D LESLIE MALE
Pr Date of Death Age If Veteran of U.S.Armed Forces,
12/27/2013 57 War or Dates
Place of Death i Hospital, Institution
City,Town or Village City of Albany or Street Address ST. PETER'S HOSPITAL
Manner of Death ® Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Cause Circumstances Investigation
Medical Certifier Name Title
LUIZ COELHO MD
Address
315 S. MANNING BLVD., ALBANY NY 12208
Death Certificate Filed District Number Register Number
510 City,Town or Village City of Albany 101 2492
Date Cemetery or Crematory
❑ Burial 01/03/2014 VERMONT CREMATION SERVICES
❑ Entombment Address
® Cremation BENNINGTON, VT
Date Place Removed
Removal and/or Held
❑ and/or Address
Hold
Transportation Date Point of
❑ By Common Shipment
Carrier
Destination
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
=' Permit Issued To Registration Number
Name of Funeral Home TUNISON F.H. 01730
Fgii Address
!:,..4 105 LAKE AVE., SARATOGA SPRINGS NY 12020
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
A
ge Pr-64ermission is hereby granted to dispose of the human remains des '•ed above as indicate..
Date 12/30/2013 Registrar of Vital Statistics ` - ' 1``ftq — -
ri Issued (signature)
we District Number 101 Place City of Albany, NY
tril
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition I/3114 Place of Disposition 2r,�+6.+ t—c.0
Uri (address)
w
(section);� (I number) (grave number)
Cl,
Z Name of Sexton or Person in Charge of Premises f,,'Ifolic ci'4,4-
t. (please print)
Signature d_ii«.— Title Gla mAidt,
(over)
DOH-1555 (02/2004)