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Leonard, Patricia Shannon 17Sj NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ti V Name First Middle Last Sex Patricia Shannon Leonard Female Date of Death Age If Veteran of U.S.Armed Forces, ', 12/04/2020 96 Years War or Dates �. Place of Death Hospital,Institution or tu Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause 0 Accident D Homicide El Suicide 0 Undetermined El Pending W U Circumstances Investigation QMedical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 s Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 554 Date Cemetery,Crematoryor FacilityName ;;�Burial rY� ,: 12/08/2020 Pine View Crematory ❑Entombment Address puCremation Queensbury Town,New York 16 ❑Donation His Z Date Place Removed .0El Removal H and/or and/or Held Hold Address 0 Cl)IL Li Transportation Date Point of p by Common Shipment Carrier Destination ::, Date CemeteryAddress h4's° Disinterment *4 ❑Reinterment Date Cemetery Address Y. Permit Issued to Registration Number :, Name of Funeral Home Alexander Baker Funeral Home 00037 s1; Address St:' 3809 Main St,Warrensburg,New York 12885 44 14- Name of Funeral Firm Making Disposition or to Whom ' Remains are Shipped,If Other than Above 2 Address CC IlI f Permission is hereby granted to dispose of the human remains described above as indicated. �-4' 12/07/2020 i Date Issued Registrar of Vital Statistics Wg6ertAnrCrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, New York A., I certify that the remains of the decedent identified above were disposed of in accordance with this mit on: Z Date of Disposition fZ/g Place of Disposition ',IL W 2 (address) ID N CC (section) Ar:„,,,Lbers,v, 1 (grave number) cName of Sexton or Person in Char of Premises , of(I Z (please print) ILI / , Signature g Title t a/PAr(bl. DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) P 1..II 2 7 3 Receipt Human remains of • delivered on , 20 • r Pine View Cemetery Representing the,funeral home named on burial permit Official Funeral Directors Reg.or License#