Leonelli, Betty Joyce .h 6 s6
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Betty Joyce Leonelli Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/07/2021 96 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Lake George Town Street Address 5 Rose Point Lane,Lake George Town,New York 12845
• Manner of Death ❑k Natural Cause Accident ElHomicide Ei Suicide Undetermined Pending
W U Circumstances Investigation
W Medical Certifier Name Title
C/ Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Lake George 5651 13
Burial Date Cemetery,Crematory or Facility Name
08/09/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury,New York
❑Donation
• Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
U) ❑Transportation
by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F.. Remains are Shipped,If Other than Above
Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2021 Registrar of Vital Statistics Patricia lafcKinney-Sclrurter(Electronicaliysigned
(signature)
District Number 5651 Place Lake George, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 8 ((((74 Place of Disposition egt� CCC t-"�0
2 (address)
W
U)
(section) //(lot number) (grave number)
G Name of Sexton or Person in Charg f Premises `Il !`s p �4.Vl4 '
(please riot)
W
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 3 5 07' 3
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#