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Bissonnette, Bruce Alan NEW YORK STATE DEPARTMENT OF HEALTH koi.V' Burial - Transit Permit Bureau of Vital Records i 4. Name First Middle---4 Last Sex Bruce Alan Bissonnette Male Date of Death Age If Veteran of U.S.Armed Forces, 06/12/2023 75 Years War or Dates F• Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 1411 Rt.9 lot 14,Moreau Town,New York 12828 ILJ p Manner of Death n Natural Cause Accident n Homicide Suicide nUndetermined ❑Pending W 0 1 fI I(Circumstances Investigation W Medical Certifier Name Title G Christopher Thomas MD Address 11 Hampstead Place,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 29 HBurial Date Cemetery,Crematory or Facility Name O6/14/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held !— Hold Address N 0 t1 Date Point of to Transportation Q by Common Shipment Carrier Destination Date Cemetery Address Ei Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom E.. Remains are Shipped,If Other than Above 2 Address LC WI a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/13/2023 Registrar of Vital Statistics Brenda Rutter(Electronically Signed) (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: IH Z Date of Disposition to(it,I Z3 Place of Disposition F,J) Ili (address/ W NCC (section) (lot number/ (grave number/ Q /n, L lt' O Name of Sexton or Person in Charge of remises C ��/n lease print/ W /�1 Title (2FsM �✓l Signature DOH-1555(07/18)p 1 of 2 .' • + I 7 0 v Public Health Law Sec. 4145(2b) f11' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#