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Leombruno, Joyce NEW YORK STATE DEPARTMENT OF HEALTH 1..CP Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Joyce Leombruno Female Date of Death Age If Veteran of U.S.Armed Forces, 11/28/2020 93 Years War or Dates i., Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital `p Manner of Death 0 Natural Cause Accident D Homicide ElSuicide Undetermined Pending V Circumstances Investigation LLI 0 Medical Certifier Name Title Abigail Macomber PA Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 536 ©Burial Date Cemetery,Crematory or Facility Name 12/04/2020 Pine View Cemetery Entombment Address LICremation Queensbury,New York ❑Donation gEl Removal Date Place Removed and/or and/or Held Hold Address N 0 Q. Date Point of f/) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1- Remains are Shipped,If Other than Above 2 Address W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2020 Registrar of Vital Statistics Ro6ertf7ndrew Curtis gkctronicaLySigned (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: If— W Date of Disposition 1 2/4/2 0 2 0 Place of Disposition 21 Quaker Rd. Queensbury , NY 12804 2 (address) w Mohican 71 A 2 N CC (section) (tot number) (grave number) 0 Name of Sexton Person in Charge of Premises Connie Goedert (please print) W Signature Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012825 Receipt Human remains of + delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# :'', Leombruno NAME Joyce Leombruno Age: g 3 Is Lot Owner: Daniel J. & Joyce M. Leombruno Lot# Mohican 71 A Grave# 2 Case: Concrete Died: 1 1 /2 8/2 0 2 0 Interred: 1 2/4/2 0 2 0 Funeral Home: Singleton Sullivan Potter FH Cemetery: Pine View