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Bujanowski Sr, John NEW YORK STATE DEPARTMENT OF HEALTH ' 7 Vital Records Section `. Burial - Transit ermit Name Firs Middle Last; Sex ohn Edgar u�anowski Sr. Male Date of Death Age If Veteran of U.S. Armed Forces, 10/22/2013 77 years War or Dates 1953-1959 f4. Place of Death Hospital, Institution or City, TXJ&X�4O Saratoga Springs Street Address Saratoga Hospital Manner of Death m Natural Cause 0 Accident 0 Homicide 0 Suicide ri Undetermined ri Pending W Circumstances Investigation W Medical Certifier Name Title 0 Ayesha Sooriabalan M D Acl,1 shurch Street, Saratoga Springs, N Y 12866 Death Certificate Filed District Number Register Number ni City, TXMPS00149( Saratoga Springs 4501 426 D Burial Date Cemetery or Crematory 10/23/2013 Pineview Crematorium ❑Entombment Address ©Cremation Queensbury N Y Date Place Removed z Removal and/or Held 42❑and/or Address H Hold It) Q Date Point of t 0 Transportation Shipment G by Common Destination Carrier Q Disinterment Date Cemetery Address Q Reinterment Date Cemetery Address Permit Issued to Registration Number al Name of Funeral Home Compassionate Care, Inc. 00364 Address 402 Maple Avenue, Saratoga Springs, N Y 12866 Name of Funeral Firm Making Disposition or to Whom 14. Remains are Shipped, If Other than Above 2 Address Ir. w Permission is hereby granted to dispose of the human remars,e ri d a� indicat Date issued 10/23/2013 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: al Date of Disposition_ t0 f MMMOO Place of Disposition Z IA%) ( orm— (address) al tfl CC (section) Clot number) r (grave number) Name of Sexton or Person . Charge o Premises twit (pl ase print) Signature Title c lt4t}Tda (over) DOH-1555 (02/2004)