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Bruce, Bernard NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Bernard W. Bruce Male Date of Death Age If Veteran of U.S. Armed Forces, Dec. 5, 1998 85 War orDatebTo No Place of Death Hospital, Institution or City, Town or Village Saranac Lake Street Address Adrk Med. Centre Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title David Thomashaw, MD Address 46 Church St. , Saranac Lake NY Death Certificate Filed Saranac Lake Dis r�c �lumber. Register Number City, Town or Village Date Cemetery or Crematory ❑Burial Dec. 8 , 1998 Pine View Crematory Address Glens Falls, NY i❑Cremation FDate Place Removed 0❑Removal and/or Held �• and/or Address Hold 0 Date Point of y❑Transportation Shipment by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address . Permit Issued to Registration Number Name of Funeral Home M R Clark, inc 00378 s> Address 27 Saranac Ave. , Lake Placid, NY 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 r m i s described above a indicated. Date Issued 12 5/9 8 Re istrar f Vital Statistics / g signature), p 166 �12_ Plac District Number L I certify that the remains of the decedent identified above were disposed n accordance with this permit on: F / q �y WZ Date of Disposition/ `J O Place of Disposition/� %t(�l�4.� /�, /j✓J/�/o r U (address) i:✓U £>E: (section) (lo�j ,b r) (grave number) inName of Sexto or Perso in Charge of Premises ����f7 of z (please print) Signature . ' �T Title DOH-1555 (10/89) p. 1 of 2 VS-61