Pansini, Bruce NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
'a r;p Name First Middle Last Sex
Bruce J. Pansini Male
:.: Date of Death Age If Veteran of U.S. Armed Forces,
November 19,2013 64 War or Dates
.,. Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
0,1 Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
AP Circumstances Investigation
it, Medical Certifier Name Title
Timothy E.Murphy Mr
Address
"; 52 Haveland Ave.,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
,, City, Town or Village Glens Falls 5601 1-4 q -2-
0 Burial Date Cemetery or Crematory
November 22,2013 Pine View Crematory
El Entombment Address
®Cremation 21 Quaker Rd.,Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date Cemetery Address
`:I Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
A Name of Funeral Firm Making Disposition or to Whom
;lam, Remains are Shipped, If Other than Above
:5° Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 1 1 / 2 I /(3 Registrar of Vital Statistics l/ CA )A-yNR, (A)A^-
(signature)
District Number 5601 Place Glens Falls, Al U
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ''
W Date of Disposition lI-ZL-t3 Place of Disposition 'J Ct+rclo n.-
W (address)
CO
CL (section) (grave number)
pName of Sexton or Person in Charge of P emises /Ift(irbrimber)Lii.46
Z (pldase print)
W A
Signature Title (.'ls'ompro1L
(over)
DOH-1555 (02/2004)