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Bruce, Richard C. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Richard C.Bruce Male Date of Death Age If Veteran of U.S.Armed Forces, 03/25/2020 86 Years War or Dates F— Place of Death Hospital,Institution or WCity,Town or Vittage Granville Village Street Address Granville Center for Rehabilitation and Nursing p Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined ❑Pending W Circumstances Investigation 0 W Medical Certifier Name Title Thomas Kandora MD Address 17 Madison St,Granville Village, New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville Village 5725 11 Burial Date Cemetery,Crematory or Facility Name 03/27/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation Z ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N O a Date Point of N El Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address ❑�interment 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 IM W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2020 Registrar of Vital Statistics Richard Roberts(Electronically Signed) (signature/ District Number 5725 Place Granville Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H � Z Date of Disposition 'j~'Zg.-2aZv Place of Disposition �yj �1u�t zre W /address/ 2 W U (Section) I (lot numb l (grave number/ Name of Sexton or Person' Ch e of Premises l v� 'n�`��� (please print) Z W Signature Title rn 4-kIA G�e DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013475 Receipt 1 { , , Human remains of delivered on , 2W- Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# -+°