Graves, Bruce E 1...C... ,� -166
NEW YORK STATE DEPARTMENT OF HEALTHBurial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bruce E.Graves Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/24/2022 85 Years War or Dates 1955-1958
Place of Death Hospital,Institution or
City,Town or Village Albany Street Address Albany Medical Center Hospital
MI
0 Manner of Death ❑X Natural Cause nAccident Homicide Suicide ❑Undetermined Pending
Ua Circumstances Investigation
ILI Medical Certifier Name Title
Alon Jacobs-Friedman NP
Address
43 New Scotland Ave,Albany,New York 12208
DeaEth Certificate Filed City Of Albany District Number Register Number
City,TownorVillage 1 0101 2193
Burial Date Cemetery,Crematory or Facility Name
09/26/2022 Pineview Crematorium
Entombment Address
Cremation Queensbury Town,New York
❑Donation
Z Date Place Removed
Removal
0 and/or and/or Held
VJ Hold Address
f
Date Point of
Transportation
by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
tReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Mason Funeral Home 01117
Address
18 George St Po Box 277,Fort Ann,New York 12827-0277
Name of Funeral Firm Making Disposition or to Whom
1... Remains are Shipped,If Other than Above
,3 Address
it
1.1
A. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/26/2022 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed)
(signature)
District Number 0101 Place City Of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition °(I 21i 11 Place of Disposition -F�,„t / r,,,__
im
g (address)
IX (section) � (lot number) � (grave number)
8' Name of Sexton or Person in Charge of remises /ttt/'+ t K
(prase print)
Signature lr xm
g � Title ooe
DOH-1555(07/18)p 1 of 2
• n rz
c, C
Public Health Law Sec. 4145(2b)
Receipt
-" /7-1.1 '
Human remains of - - --- delivered on / , 20
Pine View Cemetery Representing the funeral home named/oututiS;peyfinit
Official Funeral Directors Reg.or License# •