Kilburn, Bruce W NEW YORK STATE DEPARTMENT OF HEALTH Burlap - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Bruce W.Kilbum Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/01/2023 73 Years War or Dates
ZPlace of Death Hospital,Institution or
IIJ City,Town or Village Warrensburg Town Street Address 46 Moose Ridge Road,Warrensburg Town,New York 12845
p Manner of Death JJ Natural Cause ❑Accident El Homicide nSuicide Undetermined Pending
W v Circumstances Investigation
WG Medical Certifier Name Title
Melanie Duerr NP
Address
47 Tom Phelps Lane,Mineville Hamlet,New York 12996
Death Certificate Filed Town Of Warrensburg District Number Register Number
City,Town or Village 5660 3
Burial Date Cemetery,Crematory or Facility Name
02/03/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
SD ate Dater Place Removed
and/or and/or Held
Hold Address
O
a Date Point of
Transportation
a by Common Shipment
Carrier Destination
ODisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
f.. Remains are Shipped,If Other than Above
2 Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/03/2023 Registrar of Vital Statistics Pamela Mf Lloyd(ECectronicalTySigned)
(signature)
District Number 5660 Place Town Of Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition 2_y Zoz3 Place of Disposition 7; NJe LJ,(e,,,)
(address)---
CC
W
N (section) (lot number) (grave number)
,o
B Name of Sexton or Person in Charge f Pre ise j97/" dCe
Z (please print)
W Signature f Title Q�P��`r
DOH-1555(07/18)p t of 2
1 Public Health Law Sec. 4145(2b)
Receipt
1
1 Human remains of delivered on , 20
1
t
1
, Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#