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Barrett Jr., Leo A
NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Leo A.Barrett Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2021 52 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death © Natural Cause ❑Accident Ell Homicide ❑Suicide ❑Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title G Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 555 ❑Burial Date Cemetery,Crematory or Facility Name 12/01/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation ElRemoval Date Place Removed and/or and/or Held H Hold Address O O. Date Point of (I) ❑Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F Remains are Shipped,If Other than Above 3 Address OC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2021 Registrar of Vital Statistics W96ertAndrew Curtis(E(ectronicalTy 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: 2 W Date of Disposition /a-y ZpL/ Place of Disposition �i ry/e t`e,r,J C 1+0 2 (address) W CCCC (section) (lot number) (grave number) gName of Sexton or Person in C rge of Pre f� T ise M OA) W /!p ease print/ Signature .) G L Title DOH-1555(07/18)pi of 2 ",)hf Y Ye' Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#