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Leombruno, Margaret Passineau Z31 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Margaret Passineau Leombruno Female Date of Death Age If Veteran of U.S.Armed Forces, 11/21/2020 85 Years War or Dates II— Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 5 LaClaire Street,Hudson Falls Village,New York 12839 `p Manner of Death ©Natural Cause Accident El Homicide ❑Suicide ❑Undetermined Pending V Circumstances Investigation ILI G Medical Certifier Name Title Howard Silverberg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hudson Falls Village 5726 37 12 Burial Date Cemetery,Crematory or Facility Name 11/24/2020 Pine View Crematorium ❑Entombment Address Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held - Hold Address 0 (I) 1-1 Transportation Date Point of p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom I— Remains are Shipped,If Other than Above M Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/23/2020 Registrar of Vital Statistics Cynthia Bard n('ECectronicallySigned) (signature) District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on: W Date of Disposition NV 20 Place of Disposition (address) W CC (sedan) /lot number) (grave number/ Name of Sexton or Person in Ch ge of Premises p4 ��!'v►4 t1 Olee print/ Signature Title (122 t L DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 0 1 4 2 2 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial.pern it Official Funeral Directors Reg.or License# •