Catone, LeRoy Edward Sr. NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records
u= Burial - Transit Permit
Name First Middle Last Sex
LeRoy Edward Catone Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/13/2023 67 Years War or Dates
F, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
W
p Manner of Death ❑X Natural Cause Accident []Homicide Suicide Undetermined ❑Pending
U Circumstances Investigation
QMedical Certifier Name Title
Gamal Khalifa 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 32
Burial Date Cemetery,Crematory or Facility Name
01/19/2023 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
Q❑Removal Date Place Removed
and/or and/or Held
~ Hold Address
()
0
Q. Date Point of
Cl)0Transportation
p by Common Shipment
Carrier Destination
ODisinterment Date Cemeteryy Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street, P.O.Box 67, Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
E_ Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/18/2023 Registrar of Vital Statistics Megan Wolin(ECectronica1Ty 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:
/J_
W Date of Disposition (I li q3 Place of Disposition V /�,YL�
v
g (address)
W
CO
CC (section) A,,...,,,..,number) (grave number)
tt
0 Name of Sexton or Person in Charge of e isesZ (pleas
erint/
W Signature Title '� 'I'1 I v"C
DOH-1555(o7/18)p 1 of 2
016608
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#