Bruce, William NEW YORK STATE DEPARTMENT OF HEALT:I. 11Zf Vital Records Section lk
Burial - Transit Permit
s Name First Middle Last Sex
A
William Bradley Bruce Male
Date of Death Age If Veteran of U.S. Armed Forces,
02/13/2016 78 War or Dates
‘'of Death Hospital, Institution or
Cit own or Village Glens Falls Street Address GLENS FALLS HOSPITAL
anner of Death a Natural Cause Accident Homicide Ej Suicide 0 Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Farhana Kemal, MD,
Address
100 Park St. Glens Falls, NY 12801
D Certificate Filed „ ,— // District Number Register Number
it ,town or Village ����� 6/t.S L 6 ) b
'; 4 Burial Date or Gr$mat ry., /�.,
02/16/2016 ''-� //-e a,-�cyj'6e/ c)e'/C,�z.7
_. ❑Entombment Address ,
®Cremation ( is ,..CAYaf �� 1 4y�
Date PI Removed
Removal and/or Held
•
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
Lj
s Disinterment
Date Cemetery Address
P 4 Av Reinterment Date Cemetery Address
-ri
� Registration Number
~ ,. Permit Issued to
Name of Funeral Home Barton-McDermott Funeral Home, Inc. 00141
Address
','` 9 Pine St/P.O. Box 455 Chestertown NY 12817
,- Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 24 i b ) 1 b Registrar of Vital Statistics �
(signature)
, District Number 5 Go ( Place 5CQ�/r.S 5a. \ 5
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
' Date of Disposition 2/!'lilt Place of Disposition �mOa.,/ r`''wmc-tcf wN-
' (address)
P _ (section) (ti>tj'L-_(lot number) (grave number)
Name of Sexton or Person in Charge ofPremises (pease print)
Signature tT( Title ( 'tiE*P(t
(over)
DOH-1555(02/2004)