Bunnell, John Edward if olsg
NEW YORK STATE DEPARTMENT OF HEALTH die ' '.. Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
John Edward Bunnell Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/08/2020 67 Years War or Dates
.... Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 158 Bay Street Apt.2,Glens Falls,New York 12801
p• Manner of Death J Natural Cause 0 Accident Ei Homicide 0 Suicide ❑Undetermined Pending
O Circumstances Investigation
ILICI
Medical Certifier Name Title
Timothy Murphy Coroner
Address
52 HAVILAND AVE,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 509
0 Burial Date Cemetery,Crematory or Facility Name
11/12/2020 Pine View Crematory
❑Entombment Address
K❑Cremation Queensbury Town,New York
Donation
ZDI Removal Date Place Removed
and/or and/or Held
F- Hold Address
N
0
O. Date Point of
(n LI Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
E— Remains are Shipped,If Other than Above
5 Address
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/12/2020 Registrar of Vital Statistics p6ertAufrew Curtis ghectronrcaiySigned)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition II ij2 I ZO Place of Disposition
v
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2 (address)
W
N IX (section) 1 (lot number (grave number)
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S Name of Sexton or Person in Charge of Premises '� .��. Qnnnti��
Z (p ase print)
ul Signature Title r ' 1�T1 rf
DOH-1555(018)p 1 of 2
Public Health Law Sec. 4145(2b) " s 141.99
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# • '