Bruno, Donald E ' '''V. . 4- 1
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last I Sex
Male
Donald E Bruno
Date of Death I Age I If Veteran of U.S.Armed Forces,
08108C2022 67 Years War or Dates 1974-1977
F„, Place of Death Hospital,Institution or
Z City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing
`
Manner of DeathUndetermined ❑Pending
Ip �NaturalCause DAccident �Homicide Suicide �Circurnstances Investigation
0 Title
W Medical Certifier Name
0 Shardul Koppar DO
Address
10421 State Route 40,Granville Town,New York 12832
Death Certificate Filed District Number Register Number
Town Of Granville 5756 53
City,Town or Village
Burial Date Cemetery,Crematory or Facility Name
O8
/10/2022 I Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
DDonation
Date I Place Removed
0❑Removal and/or Held
H and/or
N
Hold Address
0
Point of
a)°Transportation Date Shipment
Q by Common
Carrier Destination
Date Cemetery Address
❑Disinterment
Date Cemetery Address
Reinterment
JD
Permit Issued to'> Registration Number
Name of Funeral Home
Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/09/2022 Registrar of Vital Statistics jenny Linda gt.1Ia,telk( Ye1tFvnu ,5gne 9
(signaturel
District Number 5756 Place Town Of Granville
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F � I' 4-.._.
WDate of Disposition 81191 ZZ Place of Disposition -I 'ntYt_
2 (address/
W
CC CC (section/ (lot number/ c (grave nunberl
0 Name of Sexton or Person in Charge of Pre ises r. 4L y
z
/� (p se print/ ,/� -~
W Signature Title aV I1��
DOH 1555(07/18)p 1 of 2
PUBLIC HEALTH LAW
§ 4145. Deaths; burial and removal permits; disposition of remains. 1. No person in charge of any premises on which
interments, cremations or other disposition of the body of a deceased person are made shall inter or permit the
interment or other disposition of any body unless it is accompanied by a burial,cremation or transit permit,as provided
in this article.
2.(a) The funeral director or undertaker shall deliver the burial permit to the person in charge of the place of burial or
other disposition before interring or otherwise disposing of the body or shall attach the removal or transit permit to the
box containing the body,when shipped by any transportation company,which permit shall accompany the remains to its
destination, where, if within this state, it shall be delivered to the person in charge of the place of burial or other
disposition.
(b)Any person or other entity owning,operating,managing or designated to receive the body of a deceased person at a
place of burial, cremation, or other final disposition in this state, who receives the body of a deceased person, shall
provide a receipt for the body to the funeral director, undertaker or registered resident who delivered such body. Each
receipt shall (i) be endorsed by both such person and the funeral director, undertaker or registered resident, (ii) indicate
the date the body was delivered, (iii) include the name of the funeral director, undertaker or registered resident
delivering the body and the registration number of such funeral director, undertaker or registered resident, (iv) include
the name of the registered funeral firm the funeral director,undertaker or registered resident represents, (v) include the
name of the deceased person as it appears on the burial, cremation,or transit permit, and (vi) include the name of the
owner,operator, manager,or person in charge of the place of burial,cremation, or other final disposition who received
the body of the deceased person.A copy of such receipt shall be retained by the owner,operator,manager,or person in
charge of the place of burial,cremation, or other final disposition for a period of not less than four years, and shall be
made available for inspection by the division of cemeteries during normal business hours.The original copy of every such
receipt shalt be retained by the licensed funeral firm for a period of not less than four years pursuant to the rules and
regulations of the department governing the maintenance of records.
3.The person in charge of the place of burial or other disposition shall endorse upon the permit,the date of interment,
or cremation or other disposition over his signature, and shall return allpermits so endorsed to the registrar of his
P g g
district within seven days after the date of interment,cremation or other disposition.
4. When burying or otherwise disposing of the body of a deceased person in a cemetery or burial place having no
person in charge,the funeral director or undertaker shall(a)sign the burial or removal permit,giving the date of burial;
(b) write across the face of the permit the words"No person in charge;"and (c) file the burial or removal permit within
three days with the registrar of the district in which the cemetery is located.
5.The person in charge of the place of burial,cremation,or other disposition shall keep a record of all bodies interred or
otherwise disposed of on the premises under his charge,in each case stating the name of each deceased person,place of
death, date of burial or disposal, and name and address of the funeral director or undertaker,which record shall at all
time be open to official inspection.
DOH 1555(07/18)p 2 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#