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Dimick Jr., Leon E
#c`9 NEW YORKSTATE DEPARTMENT OF HEALTH • .. Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Male Leon E Dimick Jr Date of Death Age If Veteran of U.S.Armed Forces, 08/09/2021 50 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death ©Natural Cause Accident Homicide Suicide 0 Undetermined Pending 0Circumstances Investigation 0 Medical Certifier Name Title George Siniapkin MD Address 604 N Palmer N Avenue,Corinth Town,New York 12822 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 334 EjBurial Date Cemetery,Crematory or Facility Name 08/11/2021 Pineview Crematory ElEntombment Address ElCremation Queensbury Town,New York El Donation Date Place Removed ZOEl Removal and/or Held F- and/or W - Hold Address 0 Date Point of (A Transportation Shipment p by Common Carrier Destination Date Cemetery Address IDDisinterment Date Cemetery Address ElReinterment 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 i— Remains are Shipped,If Other than Above a Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2021 Registrar of Vital Statistics Robert Andrew Curtis(Electronically Signed) (signature) District Number 5601 Place Glens Falls, 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 If(11 i 21 Place of Disposition F/It.t/L.--aress) W N ( ) (lot number) (grave number) CC 411;% , .On�� O• Name of Sexton or Person in Charge of P ises (p se print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 15035 Receipt A Human remains of *- delivered on 20 Pine View Cemetery Representing the funeral home named(in burial permit Official Funeral Directors Reg. or License#