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McLeod Sr., George Curtis -IF 1000 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex `i George Curtis McLeod Sr Male Date of Death Age If Veteran of U.S.Armed Forces, 11/23/2021 90 Years War or Dates 1952-1955 Place of Death Hospital,Institution or City,Town or Village Glens Falls Street Address 11 Fort Amherst Road,Glens Falls,New York 12801 Manner of Death ©Natural Cause El Accident Homicide Suicide ❑Undetermined ❑Pending Circumstances Investigation 111 Medical Certifier Name Title a Sean Campanie NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 536 ▪Burial Date Cemetery,Crematory or Facility Name 11/24/2021 Pine View Crematory Li Entombment Address 0 Cremation Queensbury Town,New York ▪Donation Z❑Removal Date Place Removed No and/or and/or Held F Hold Address N 0 CL Date Point of fA❑Transportation a by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address - ▪Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address 1. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/24/2021 Registrar of Vital Statistics cRg6ert Andrew Curtis(EfectronicalrySigned) (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: till Date of Disposition //_.29t2 2/ Place of Disposition e , Q U -e _) Cct_ vl k 2 (address) ill N (section) _ (lot numbfr) L� (grave number) a ChargeJ(i4 ) pe.f /A/� Name of Sexton or Person in of Premises (please print) W Signature 7-9 // t Title ev DOH-1555(07/18)p 1 of 2 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#