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Robbins,Bruce Dale NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bruce Dale Robbins Male Date of Death Age If Veteran of U.S.Armed Forces, 12/25/2020 72 Years War or Dates f.. Place of Death Hospital,Institution or Z City,Town or Village Lake Luzeme Town Street Address 25 Colony Drive, Lake Luzerne Town, New York 12846 pManner of Death ©Natural Cause Accident Homicide 1=1Suicide Undetermined Pending 0 Circumstances Investigation 0 Medical Certifier Name Title Mary Stein NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Lake Luzerne 5656 21 ElBurial Date Cemetery,Crematory or Facility Name 12/28/2020 - Pine ViewCrematorium Entombment Address 0 Cremation Queensbury Hamlet,New York Donation gRemoval Date Place Removed and/or and/or Held f- Hold Address 0 d. Date Point of co 11 Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom i- Remains are Shipped,If Other than Above a Address CC UJ Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/28/2020 Registrar of Vital Statistics Cynthia Sherwood(Efectronica1tySigned) (signature) District Number 5656 Place Lake Luzerne, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition `/-,z f-Z.-70 Place of Disposition ,�C -c1.3 C rt:in 410 r „( UJ 2 (address W CC (section) (lotnumberr) (grave number) O Name of Sexton or Person in arge of re ' es �/ M� C' E Z (please print) W Signature r �� Title 0e DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014 4 0 Receipt Human remains of delivered on ' , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#