Leonard, Barbara NEW YORK STATE DEPARTMENT OF HEALTH, 4 2-7-11
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Barbara Jean Leonard Female
Date of Death Age If Veteran of U.S. Armed Forces,
03/12/2018 91 War or Dates NA
Place of Death Hospital, Institution or
Z City, Town or Village Village of Fort Ann,NY Street Address 23 Queen Anne Drive,Fort Ann,NY
Manner of Death ! I Natural Cause I I Accident n Homicide Suicide n Undetermined n Pending
Circumstances Investigation
W Medical Certifier Name Title
David Foote,MD
Address
340 Main St.Hudson Falls,NY
Death Certificate Filed District Number Register dumber
City, Town or Village Village of Fort Ann,NY 5 '7c 3 /
❑Burial Date Cemetery or Crematory
Entombment 03/17/2018 Pine View Crematory
Address
Cremation Queensbury,NY
Date Place Removed
ZZ r7 Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier _
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd.,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
Address
W
a' Permission is hereby granted to dispose of the human ren7ins described abo a indicated.
Date Issued 3- l5--c.R / (Registrar of Vital Statistics 742 --')
(signature)
District Number j 7 3 Place L� ` /'7
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition alit,it g Place of Disposition 1'u vti Ct,/
(address)
N
ce (section) (lot number,);./ (grave number)
pName of Sexton or Person in Charge f Premises (I,. "�"
Z lease print)
W
Signature Title amm
(over)
DOH-1555(02/2004)