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NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bruce Anthony Clear Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/06/2022 58 Years War or Dates
Place of Death Hospital,Institution or
Z
City,Town or Village Queensbury Town Street Address 31 Briwood Circle, Queensbury Town, New York 12804
p Manner of Death Natural Cause IllAccident []Homicide DSuicide []Undetermined ❑Pending
W ' 'Circumstances Investigation
C.)
W Medical Certifier Name Title
Shannon Evellis PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 94
Burial Date Cemetery,Crematory or Facility Name
06/09/2022 Pine View Crematorium
Entombment Address
[]Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
Hold Address
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n. Date Point of
Cl)❑Transportation Shipment
p by Common
Carrier Destination
[]Disinterment
Date Cemetery Address
Date Cemetery Address
ri Reinterment
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
E.. Remains are Shipped,If Other than Above
5 Address
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a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/08/2022 Registrar of Vital Statistics Caroline.7fildegardeBar6er(Electronically Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition &I'D(it. Place of Disposition -L[..r 6
2 (address)
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