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Pratt, Bruce NEW YORK STATE DEPARTMENT O -r Vital Records Section Burial - Transit Permit Name First s. le Last Sex Bruce Le- Pratt Male Date of Death Age If Veteran of U.S. Armed Forces, December 29, 2016 51 War or Dates Place of Death - Hospital, Institution or City, Town or Village Fort Edward Street Address Manner of Death .i Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation W- Medical Certifier Name Title 14 Robert Lemieux, Address 219 Pope Hill Road Argyle, NY 12809 Death Certificate Filed District Numbers � Register�m er City, Town or Village Fort Edward ,>G ^* ❑Burial Date Cemetery or Crematory January 3, 2017 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed t❑ Removal and/or Held and/or Address Hold Date Point of CV 4, ❑Transportation Shipment Uf by Common Destination Carrier Date Cemetery Address ❑ Disinterment r3 '❑ Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 Address 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address Permission is he eby ranted to dispose of the human ns descri ell ro a indicated. Date Issued Of Registrar of Vital Statistics �� signature) District Number�7. Place i '/L t5 [ 1)a4 d certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 01/03/2017 Place of Disposition Quaker Road Queensbury,NY 12804 (address) (section) (lot}number) (grave number) /�;e{ ,, j1NAir Name of Sexton or PersonChargQ of Premises A[i� (p ase print) E Signature _ Title (R-nW . (over) DOH-1555 (02/2004)