Bruce, Ronald NEW YORK STATE DEPARTMENT OFv1E.RL;H ZJ
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ronald Bruce Male
Date of Death Age If Veteran of U.S. Armed Forces,
December 17,2016 70 War or Dates
,: Place of Death Hospital, Institution or
City, Town or Village Johnsburg Street Address 64 Main St.
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
10 Circumstances Investigation
,tu Medical Certifier Name Title
_ : Chris Jackson PA
- Address
HHHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655
❑Burial Date Cemetery or Crematory
El
Entombment December 23,2016 Pine View Crematory
Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
—_I— Hold
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0 Date Point of
N _Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
•
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
-° Remains are Shipped, If Other than Above
Address
A Permission is hereby granted to dispose of the human remai s described ove as i i ted.
' Date Issued — / 9, ) 2egistrar of Vital Statistics (.� �q
si nature)
District Number �5 Place « lNk
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I certify that the remains of the decedent identified above we isposed of in accordance wit this permit on:
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u.I Date of Disposition %2123//W Place of Disposition 4'16 tJ j Ui.c) Cceyh4 k 7"
2 // (address) /
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0 (section) / (lot number) (grave number)
QName of SextonPftrso in Charge of Premisesj t, /.a.r1 [��*-- 4�4 e
Z (please print)
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Signature Title r2 incl. ilo
(over)
DOH-1555 (02/2004)