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Bulman, Michael Peter 0) (L .!) NEW YORKSTATE DEPARTMENT OF HEALTH \� Burial - Transit Permit Bureau of Vital Records ' Name First Middle Last Sex Michael Peter Bulman Male Date of Death Age If Veteran of US.Armed Forces, 08/19/2023 74 Years War or Dates 1968-1973 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending El Natural Cause Accident Homicide Suicide W Circumstances Investigation W Medical Certifier Name Title G Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 392 Burial Date Cemetery,Crematory or Facility Name 08/22/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address V) 0 Date Point of Cl) Transportation Shipment p by Common Carrier Destination ElDisinterment Date Cemetery Address EIReinterment 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 1— Remains are Shipped,If Other than Above 2 Address Cr W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/21/2023 Registrar of Vital Statistics Megan.No(in(E(ectronicaCCy Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition g/t 4 I 0Place of Disposition �d11-) W Cl)CC (section)Name of Sexton or Person in Charge of Premises /riot number) (grave number) 1�L /f 8 /p/ea#e print/ WSignature /,/ Title nr•f ' DOH-1555(o7/t8)p 1 of 2 - ` �4 �2 2 0 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# i