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Ledger, Aldoria Evariste i T Iv' : NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Aldoria Evariste Leger Male Date of Death Age If Veteran of U.S.Armed Forces, 08/30/2023 89 Years War or Dates Army i_ Place of Death Hospital,Institution or W City,Town or Village Queensbury Town Street Address 34 Amethyst Drive,Queensbury Town, New York 12804 O Manner of Death ZI Natural Cause Accident ❑Homicide ii Suicide I=IU Pending W Circumstances Investigation W Medical Certifier Name Title O John Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 137 Burial Date Cemetery,Crematory or Facility Name .1 09/01/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury,New York ElDonation O❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 0• Date Point of (f)EITransportation G by Common Shipment Carrier Destination O Disinterment Date Cemetery Address OReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom -. Remains are Shipped,If Other than Above a Address it IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/01/2023 Registrar of Vital Statistics Caroline x1legarde Barber(E(ectronica((y Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 9120Z3 Place of Disposition ,0 Q if-e,.J C!` 4.-ta r Ili (address) W 1 (section) (lot n tuber) (grave number) SName of Sexton or Person in Charge Premise ' `fYrn O4� 'Ion C Z (please print) W Signature Title O 22J 17 g DOH-1555(07/18)pi.of 2 I 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#