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NEW YORKSTATE DEPARTMENT OF HEALTH 'fi
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Bruce Alan Denny Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/23/2022 65 Years War or Dates 1976-1980
F Place of Death Hospital,Institution or
Z City,Town or Village Moreau Town Street Address 448 Gansevoort Road,Moreau Town,New York 12828
Ili
p Manner of Death ❑X Natural Cause Accident Homicide OSuicide ElUndetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Mark Quaresima MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Moreau District Number Register Number
City,Town or Village 4562 56
Burial Date Cemetery,Crematory or Facility Name —
10/26/2022 Pine View Crematory
_,Entombment Address
IICremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held -
t— Hold Address
N
0
O. Date Point of
to❑Transportation Shipment
s by Common
Carrier Destination
Disinterment
Date Cemetery Address
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
5 Address
CC
Hi
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/26/2022 Registrar of Vital Statistics Leeann McCabe(E(ectronicaflySigned)
(signature)
District Number 4562 Place Town Of Moreau
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1� /I
Z Date of Disposition 10 in I it_ Place of Disposition T i a V 4...teir
ILI
2 (address)
ILLI
CC (section) A
4101-101......
(lot number (grave number)
0 Name of Sexton or Person in Charge of P .ses h
z (please print)
Hi
Signature
// Title (Pc-n'ii
DOH-1555(07/18)p 1 of 2
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F '' .. 3 o,
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#