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Cameron, Leonard G # Sat NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Leonard G Cameron Male Date of Death Age If Veteran of US.Armed Forces, 06/16/2021 67 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital LU 0 Manner of Death Undetermined Pending ©Natural Cause Accident �Homicide �Suicide � � Circumstances Investigation W Medical Certifier Name Title 0 Romel Gobunsuy MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 336 ElBurial Date Cemetery,Crematory or Facility Name 06/18/2021 Pineview Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held IH 6- Hold Address 0 a Date Point of tJ>t ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom E— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/17/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition w.-19 do,Z/ Place of Disposition Q'19P it 4Z4) C/`G01.rL,- 6 (address% W N a (section) ) (tot number) (grave number) 0 Name of Sexton or Person in Ch a of P m s ease Z (p ease print/ Signature f`7,- Title Or—CA-4 r DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 01 41870 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#