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Bunzey, Douglas A
s .1 _ ' sn NEW YORK STATE DEPARTMENT OF HEALTH , . Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Douglas A Bunzey Male Date of Death Age If Veteran of U.S.Armed Forces, 07/04/2021 43 Years War or Dates i.., Place of Death Hospital,Institution or Z City,Town or Village Hadley Town Street Address 124 Bunzey Mountain Road,Hadley Town,New York 12835 p Manner of Death ©Natural Cause ❑Accident El Homicide ❑Suicide 0Undetermined 0 Pending W 0Circumstances Investigation W Medical Certifier Name Title CI Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa Village,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 14 EBurial Date Cemetery,Crematory or Facility Name 07/07/2021 Pineview Crematory Entombment Address ▪Cremation Queensbury Town,New York ▪Donation Z Removal Date Place Removed and/or and/or Held p— Hold Address 0 G. Date Point of N ❑Transportation Shipment Q by Common Carrier Destination El Disinterment Date Cemetery Address 0 Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom s.— Remains are Shipped,If Other than Above 2 Address Er W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/06/2021 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 1— /�_ Z Date of Disposition 1/ ' Z, Place of Disposition �r 4---- 11J ►(address W N (section) (lot number) (grave number) °C lilt`s( 1. 'I IT a Name of Sexton or Person in Charge of P ises /p/ea print/I ���! L " `"'Signature Title � � DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014915 Receipt Human remains of ,, delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#