Senecal, Bruce g
NEW YORK STATE DEPARTMENT OF HEALTH # ®
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Bruce M. Senecal Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/06/2017 56 years War or Dates
I— Place of Death Hospital, Institution or
W City, Ton=WAXX Saratoga Springs Street Address Saratoga Hospital
W Manner of Death ,Natural Cause O Accident O Homicide O Suicide El Undetermined ri O Pending
Circumstances Investigation
W Medical Certifier Name Title
Rodney Ying MD
Address
59 Myrtle Street Saratoga Springs, Ny
Death Certificate Filed District Number Register Number
City, ToXXX(*kW Saratoga Springs 4501 73
OBurial Date Cemetery or Crematory
❑Entombment 02/07/2017 Pineview Crematory
Address
QCremation Queensbury, N Y
Date Place Removed
Z Removal and/or Held
2❑and/or Address
H Hold
CO
0 Date Point of
IL
O Transportation Shipment
Et by Common Destination
Carrier
O Disinterment Date Cemetery Address
O Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home 00448
Address
7 Sherman Ave, Corinth, New York 12822
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
2 Address
cr
iI
CL
Permission is hereby granted to dispose of the human remain s 'b abouva ' dicated.
Date Issued 02/07/2017 Registrar of Vital Statistics
(signature)
• District Number 4501 Place Saratoga Springs
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
fin,tOtt,"
UI Date of Disposition 71%J 1 Place of Disposition 'r`//a�
� 'if',__
2 (address)
W
t
IX (section) ► (lot number (grave number)
pName of Sexton or Person in Charge of Premises ��(r, N....tt`f
za
lease print)
Signature L Title `ICE Pi j &
(over)
DOH-1555 (02/2004)