Leyendecker, James Anthony . 47 - 711 y6 ?
NEW YORK STATE DEPARTMENT OF HEALTH
Burial - Transit Permit
Bureau of Vital Records
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Name First Middle Last Sex
James Anthony Leyendecker Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/03/2021 61 Years War or Dates
Place of Death Hospital;Institution or
WCity,Town or Village Colonie Town Street Address 947 Loudon Road,Colonie Town,New York 12047
p Manner of Death ❑ Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑X Pending
W U Circumstances Investigation
W Medical Certifier Name Title
CI Paul Marra Coroner
Address
112 State Street,Albany,New York 12207
Death Certificate Filed District Number Register Number
City,Town or Village Colonie Town 0153 152
❑Burial Date Cemetery,Crematory or Facility Name
06/05/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
6 Removal Date Place Removed
and/or and/or Held
F-
N Hold Address
0
0- Date Point of
(I) ❑Transportation
p by Common Shipment
Carrier Destination '
Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
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
p- Remains are Shipped,If Other than Above
5 Address
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O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/04/2021 Registrar of Vital Statistics Julie ggawk(E/ctronicallySrgned)
(signature)
District Number 0153 Place Colonie Town, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH
W Date of Disposition (pIDA
71 Place of Disposition ,LttL 0.�--
2 (a dress)
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CC (section) /4(lot number) (grave number)
Name of Sexton or Person in Charge o remises `'ll rl,T L Sy+^^ It
Z (pleas print)
W Signature Title G r"r'Acivr`
DOH-1555(07/18)p 1 of 2
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Public Health Law Sec. 4145(2b) v �� .lA�h Q .4 .,,,,6
Receipt
Human remains of ,,,,; . . delivered on , 20
Pine View Cemetery Representing the funeral home namedon burial permit
Official Funeral Directors Reg.or License# ,