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Bacon Sr., Leonard Arthur
c NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit ' Bureau of Vital Records Name First Middle Last Sex Leonard Arthur Bacon Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 04/17/2023 73 Years War or Dates f. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 1 S Delaware Avenue#309,Glens Falls, New York 12801 0 Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined El Pending Circumstances Investigation W0 Medical Certifier Name Title 0 Scott Miller PA 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 202 Burial Date Cemetery,Crematory or Facility Name 04/18/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address 0 a Date Point of N IllTransportation Q by Common Shipment Carrier Destination ODisinterment 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 F Remains are Shipped,If Other than Above 2 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/18/2023 Registrar of Vital Statistics Megan Win(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: Z W Date of Disposition y Z©-Z.0g� Place of Disposition ?:J Q (address) W CIC N (section) _ t �! (lof number) (grave number) 8 Name of Sexton or Person in Charge of semis 1�►�i/�p� �u t/!� (please print) W Signature �' Title U U ee g DOH-1555(07/18)pi of 2 .-1. on 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#