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Bunalski Leonard J. �#nZ NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Leonard J Bunalski Male Date of Death Age If Veteran of U.S.Armed Forces, 02/19/2020 74 Years War or Dates 1962-1966 Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc 13 Mannerof Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending lu Circumstances Investigation W Medical Certifier Name Title 0 Rick Teetz MD Address 131 Lawrence St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,TownorVill Saratoga Springs 4501 121 ❑Burial Date Cemetery,Crematory or Facility Name ❑Entombment 02/21/2020 Pine View Crematory Address XJ Cremation Queensbury Town,New York ❑Donation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N ❑Transportation Date Point of is by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 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 IH Remains are Shipped,If Other than Above 2 Address IM W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/21/2020 Registrar of Vital Statistics John Paulftanck(ECectronicallySigned) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition 2124170 Place of Disposition 'f�.l���ff V t` tu (address) W w (sedion/ /� (lot number,( (grave number/ 0 Name of Sexton or Person in Charge of Premises `/t`t �"'�� Z 1-se print/ W Signature Title DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 3 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#