Bruce, Wallace . v ' CI
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last ' Sex
Wallace E. Bruce Male
Date of Death Age If Veteran of U.S. Armed Forces,
05 / 02 / 2017 85 War or Dates N/A
Place of Death Hospital, Institution or
ZCity, Town or Village Saratoga Springs Street Address Saratoga Hospital
4 Manner of Death E Natural Cause --Accident Homicide _Suicide Undetermined 7 Pending
it! —Circumstances Investigation
u Medical Certifier Name Title
t Carlos A. Ares MD
Address
59 Myrtle St # 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Numb
City, Town or Village Saratoga Springs !`�c( 2-2-
Y
oBurial Date Cemetery or Crematory
05 / 04 / 2017 l Pine View Cremation
OEntombment Address
Lc Cremation Queensbury, NY
Date Place Removed
a Removal 1 and/or Held
and/or Address
0
Hold
Date Point of
oi0 Transportation Shipment
C by Common Destination
Carrier
Mi
0 Disinterment Date Cemetery Address
Date Cemetery Address
: 0 Reinterment 1
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
ni Address
402 Maple Ave. , Saratoga Sp. , NY 12866
ia Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
a Address
ILI
.P` Permission is he b granted to dispose of the human remais.4es ibed ove as indicated.
Date Issued _�� `� I Registrar of Vital Statistics ` �-
To -41)-(.4,4.
(signature)
District Number •`.--- Place Saratoga Springs New York
I certify that the rremaininsof the decedent identified above were disposed of in accordance with this permit on:
ill-
iii Date of Disposition • i s Jiii Place of Disposition °)in.V.- carn„or(Ccay.,
(address)
tii
(A
CC (section) A (lot number) (grave number)
` .
• Name of Sexton or Person it Charge of Premises ti 4 h n��"
2 ( lease print) •
Ili Signature aTitle l ciEIMi 1
(over)
DOH-1555 (02/2004)