Dudley-Bruno, Kelly Marie NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Kathy Marie Bruno Dudley Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/16/2022 55 Years War or Dates 1985-1993
a_ Place of Death Hospital,Institution or
Z City,Town or Village Kingsbury Town Street Address 9 Cherry Tree Lane,Kingsbury Town, New York 12839
pManner of Death II Natural Cause ❑Accident El Homicide Ei Suicide FlUndetermined riPending
lW Circumstances Investigation
WMedical Certifier Name Title
CI Laurie Dennison NP
Address
3 Irongate Center,Glens Falls,New York 12801
DeaRth Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 4
Burial Date Cemetery,Crematory or Facility Name
03/18/2022 Pine View Crematorium
Entombment Address
EICremation Queensbury Town,New York
DDonation
g❑Removal Date Place Removed
and/or and/or Held
H Hold Address •
N _
0
O. Date Point of
N❑Transportation Shipment
5 by Common
Carrier Destination
El
Disinterment
Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
}- Remains are Shipped,If Other than Above
2 Address
Er
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/17/2022 Registrar of Vital Statistics Cynthia ABardmn(E(ectronical(ySigned)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Z Date of Disposition ?3._)9-?oZ(Place of Disposition Pi,,�1-e U 1 ) C/'P4,a
1111
2 (address)
W
Q (section) (lot nu ber) 1 (grave number)
�,/ U^
8 Name of Sexton or Person in Charge f Premise —R A/ott 17 L �e
z
�� (� (please print)
W Signature Title plr�
DOH-1555(o7/18)p t of 2
I
• 5898
Public Health Law Sec. 4145(2b)
Receipt
Human remains of • delivered on , 20
Pine View Cemetery Representing the funeral home named.on.buFial permit
Official Funeral Directors Reg.or License#