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MacGregor, Bruce M NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bruce M MacGregor Male Date of Death Age If Veteran of U.S.Armed Forces, 09/18/2021 57 Years War or Dates i_ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 13 Culvert Street,Glens Falls,New York 12804 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending W U Circumstances Investigation ILIJ G Medical Certifier Name Title Connie Goedert Coroner Address 1400 St Route 9,Lake George Town,New York 12845 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 410 ❑Burial Date Cemetery,Crematory or Facility Name 09/22/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation g ❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of Cl) ❑Transportation Es by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury, New York 12804 Name of Funeral Firm Making Disposition or to Whom f— Remains are Shipped,If Other than Above 2 Address It W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/22/2021 Registrar of Vital Statistics Wp6ertAndrew Curtis(E&ctronicafty Signed) (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: W Date of Disposition 1 113 j t( Place of Disposition nc t (—Az—, a( (address) W IX (section) d `(lot number)c (grave number) GName of Sexton or Person in Ch a of Premises l Z 1 (p se print) /�, In Signature Title ��� DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#