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Durham Sr.Bruce Eugene # M NEWYORK STATE DEPARTMENT OF HEALTH BUriaL - Transit Permit Bureau of Vital Records Name First Middle Last Sex s Male Bruce Eugene Durham Sr. Date of Death Age If Veteran of U.S.Armed Forces, k 02/25/2020 75 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Hudson Falls Village Street Address 1 St.Paul's Drive 7H,Hudson Falls Village,New York 12839 p Manner of Death © Natural Cause Accident Homicide Suicide ❑Undetermined Ej Pending LLI Circumstances Investigation W Medical Certifier Name Title 9 Mark Quaresima MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Villa a Hudson Falls Village 5726 4 Burial Date Cemetery,Crematory or Facility Name 02/27/2020 Pine View Crematory " Entombment Address X❑Cremation Queensbury Town,New York �> Donation Removal Date Place Removed O and/or Held F- and/or N Hold Address aDate Point of to Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address IIM W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/27/2020 Registrar of Vital Statistics CynthiaABardin(ECectronicaflySigne� (signature/ District Number 5726 Place Hudson Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition Z/Z-) Zp27L Z Place of Disposition (address/ t y✓� � (section/ (lot numbe (grave number/ O' Name of Sexton or Person in Charge of Pr mises �n�I Z ���—*7 /P ase prmtl LIU Title Signature DOH-1555(o7/18)p t of 2 Public Health Law Sec. 4145(2b) 3 3 7 J Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#