Harder, Leonard NEW YORK STATE DEPARTMENT OF HEALTH 1 0i
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Leonard Arthur Harder Male
Date of Death Age If Veteran of U.S. Armed Forces,
12/06/2018 79 Years War or Dates 1956-1958
Place of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing
Manner of Death Undetermined Pending
� . 0 Natural Cause �Accident �Homicide �Suicide � �]
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
42 Gurney Ln,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 172
❑Burial Date Cemetery or Crematory
12/11/2018 Pine View Crematory
❑Entombment
Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number 9
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
gaa=
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/11/2018 Registrar of Vital Statistics Caroline?f Barber(ECectronica1CySigned)
(signature)
District Number Place
5657 Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition/ -)d--1 Place of Disposition Pj lo e
iy (address)
(section) of number) (grave number)
Name of Sexton or Person in Charge of Premises e,c M�>' 30 1 kC/5
(pease print)
Signature Title J`ierIQ+cc
(over)
DOH-1555 (02/2004)