Lee, Joseph LeRoy Town of Queensbury
p,
Certification of Cremation
s Pine View Cemetery and Crematory
This certifies that the remains of: Joseph Leroy Lee
were cremated on February , 7 20 23 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death February , 3 20 23 Age 83
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 124
(Authorized Signature)
NEW YORKSTATE DEPARTMENT OF HEALTH 1,
:y' �..-' Burial - Transit Pi.
ermit
Bureau of Vital Records -
Name First Middle Last Sex
Joseph Leroy Lee Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2023 83 Years War or Dates
F- Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Z Natural Cause Accident ❑Homicide 0Suicide Undetermined ri Pending
W
U Circumstances Investigation
QW Medical Certifier Name Title
Melody Long PA
Address
100 Park Street,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 65
Burial Date Cemetery,Crematory or Facility Name
02/06/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
F„ and/or and/or Held
N Hold Address
0
O. Date Point of
(I)❑Transportation
S by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
1— Remains are Shipped,If Other than Above
2 Address
CC
W
Cl. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/06/2023 Registrar of Vital Statistics Megan Notin(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:
H —___,.
W Date of Disposition 2�l �I3 Place of Disposition �l �
ddress)
W
U)
ft (section) / (lot number) (grave number)
SName of Sexton or Person in Charge o miser n V-- r✓l1Z (( ase print)
W Signature Title C�'K'mnck
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#
BRADWAY (r!71_ /
Lot No. 61
Address 97 Gregwood Circle, Queensbury, NY 12804 Section No. B
Owner Mr . & Mrs . Leonard Bradway Plot Mohican
Date 12/21/91
Approx . 33 Superficial ft. @
Location Bounded on North by Vacant, South by Reid, East by Vacant ,
West by Path .
Corner Posts
Remarks
Deed No. (and changes) 2401
Payment Record Paid in Full 12/21/91
Record of Interments
I Leonard M. Bradway, Sr . 12/23/91 ►
‘ aO
6
5 ,1-
Form No. 01
LEE
(Eli
NAME Joseph Leroy Lee Age: 83
Lot Owner: Mr.&Mrs. Leonard Bradway
Lot# Mohican 61 B Grave# 1A
Case: Urn
Died:2 3 .23 Interred:2. 1 0.23
Funeral Home: Baker
Cemetery: Pine View