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Bugno, Cecilia M
... . , # /OP NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Cecilia M Bugno Female Date of Death Age If Veteran of U.S.Armed Forces, 12/14/2021 87 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending VCircumstances Investigation WW Medical Certifier Name Title 0 Michael Miles MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 603 ❑Burial Date Cemetery,Crematory or Facility Name 12/16/2021 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation OZ ❑Removal Date Place Removed F= and/or and/or Held H Hold Address to ❑Transportation Date Point of S 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 ~ Remains are Shipped,If Other than Above 2 Address CC W Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/16/2021 Registrar of Vital Statistics ag6ertAndrew Curtis(E(ectronicaly 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: Date of Disposition IZf 11 171 Place of Disposition `1 :, �• tDtti� 11.1 2 (address/ • W N (section/ (lot number) (grave number) 8 CC Name of Sexton or Person in Charge of ices L. cevAiii z (piece print) / ,..�� IllSignature ......): :f Title ( M It(V�r DOH-1555(07/18)p t of 2 01 r'; c4 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#