Ramsey, Leon Michael tT ) -i q7s
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Leon Michael Ramsey Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/04/2022 59 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
LIJ
p Manner of Death g Natural Cause Accident Ill Homicide Suicide Undetermined ❑Pending
W
U Circumstances Investigation
W Medical Certifier Name Title
a Christopher Smith MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 562
RBurial I Date Cemetery,Crematory or Facility Name
11/07/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
ZO❑Removal Date Place Removed
and/or and/or Held
H
N Hold Address
0
d Date Point of
(I)❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
i- Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/07/2022 Registrar of Vital Statistics MeganNolsn gketronica4 Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Z Date of Disposition f// 12 L Place of Disposition — L_.
UJ
2 (a'dress)
IW
N CC (section) Av
lot number) (grave number)
SName of Sexton or Perso/ eofPse s g. "if
z (1)14e punt)W ��`�v
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Signature Title
DOH-1555(07/18)p 1 of 2
84
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#