Gordon, Leon NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
LEON P. GORDON KALE
Date of Death Age If Veteran of U.S. Armed Forces,
02/0411998 79 years War or Dates WW II
Place of Death Hospital, Institution or
City, Town or Village GLEN'S F`ALL'J Street Address GLENS FALLS HOSPITAL
Manner of Death Natural Cause Accident Ej Homicide Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
GERALD SC:HYNOLL M. D.
Address
2 BROAD STREET PLAZA GLENS FALLS NY 12801
€s Death Certificate Filed District Number Register Number
City, Town or Village GL
ENS FALLS 5601 76
Date Cemetery or Crematory
❑Burial 02/09/1998 PINEVIEW CREMATORY
Address
Cremation QUEENSBURY NY 12804
Date Place Removed
Z❑Removal and/or Held
Hold
-- and/or Address
Q Date Point of
Transportation Shipment
b by Common Destination
Carrier
Disinterment Date Cemetery Address
]F-]Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home JILLSON FUNERAL HONE INC 01006
Address
46 WILLIAMS STREET WHITEHALL NY 12887
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains descr' a alb vejlLsindi ed
Date Issue gg Registrar of Vital Statistics
(signature)
District Number5601 Place GLFN�FALLS
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I/'
Date of Disposition Place of Disposition !//�/tJ
(address)
UJI
M (section) �I ��Zjgrave number)
GName of Sexto or Person in harge of Premi es ,e�2 �
z please print)
Signature Title c� �r
DOH-1555 (10/89) p. 1 of 2 VS-61