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Leahy, Sandra A
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra A.Leahy Female Date of Death Age If Veteran of U.S.Armed Forces, 04/05/2023 79 Years War or Dates IH Place of Death Hospital,Institution or Z City,Town or Village Ticonderoga Town Street Address Elderwood at Ticonderoga UJ p Manner of Death ❑^ Natural Cause Accident Homicide []Suicide Undetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title G Salam Hawa MD Address 1019 Wicker St,Ticonderoga Town,New York 12883 Death Certificate Filed Town Of Ticonderoga District Number Register Number City,Town or Village 1564 24 Burial Date Cemetery,Crematory or Facility Name 04/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation IJ Removal Date Place Removed and/or and/or Held N Hold Address 0 d Date Point of (I)❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above ' Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/06/2023 Registrar of Vital Statistics 7nnya.V 2Tiompson gkctronicallysigned (signature) District Number 1564 Place Town Of Ticonderoga I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: l—Z Date of Disposition 1 L-77-€2j Place of Disposition -?; ° Vv< CrP It ' r W 2 (address) W Q (section) (lot number) (grave number) 0s Name of Sexton or Person in Charge o remise. V1414^7� �'►/ 0 (please print) W Signature /1f( `` Title (`pt�'?. `— DOH-1555(07/18)p t of 2 11•4 `-i- • 6 9 6 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#