Bujanowski, Scott NEW YORK STATE DEPARTMENT OF HEALTH'
Vital Records Section or Burial - Transit Permit
Name First Middle Last Sex
Scott Samuel Bujanowski Male
Date of Death A e If Veteran of U.S. Armed Forces,
11 / 13 / 2017 ` 47 War or Dates N/A
Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address
Saratoga Hospital
0 Manner of Death® Natural Cause Accident Homicide _Suicide — Undetermined 0 Pending
—Circumstances Investigation
tg Medical Certifier Name Title
i Susan Hayes Coroner
Address
40 McMaster St. , Ballston Spa. , NY 12020
Death Certificate Filed District Number Register Nu ber
City, Town or Village Saratoga Springs 11561 tiSI.
0Burial Date , Cemetery or Crematory
11 / 15 / 2017 Pine View Crematory
;; DEntombment Address
;I?;QCremation Queensbury, NY
Date Place Removed
Z ri Removal ; and/or Held
and/or Address
lP Hold
0 Date Point of
giQ Transportation Shipment
0. by Common Destination
Carrier
NE
Disinterment Date Cemetery Address
❑Renterment Date ; Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
!' Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
re
ILI
Permission is h reby granted to dispose of the human remains describ d abo as • dicated.
Date Issued jt i� (� Registrar of Vital Statistics --...,, ( 1•
(signature)
District Number t.�i,561 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fDate of Disposition {( /i(, In Place of Disposition f', ,,,,i f ry ,�a( .,2 (address)
ffl
CC (section) il(lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre ' es t i1!•i K ---)"4
W ,�!' (please rint) •
Signature �� '�"k' Title i iizt ei,t
(over)
DOH-1555 (02/2004)