Leonbruno, Jr. Salvatore Th6g)
F
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Salvatore Joseph Leonbruno Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
08/17/2018 88 Years War or Dates Korean
p- Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
5 Manner of Death IX Natural Cause Accident 0 Homicide n Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Wendy Steinhacker PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 394
"'Burial Date Cemetery or Crematory
08/22/2018 Pine View Crematory
['Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Removal and/or Held
2 and/or Address
tt Hold
Date Point of
Transportation Shipment
G by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
N• ame of Funeral Firm Making Disposition or to Whom
" Remains are Shipped, If Other than Above
Address
ut
Ct* P• ermission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/17/2018 Registrar of Vital Statistics c1 6ertACurtis(EkctronicaltySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tD• ate of Disposition�.- -s_.ig Place of Disposition p j V,c,jj C_t't,iw14„cy
2 (address)
ili
Ce (section) _ (lot number) (grave number)
Name of Sexton or Person in Charge of Premises efy Scaj.3u5
(please print)
Signature t Title C it,b"r14°r
(over)
DOH-1555 (02/2004)