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Bonkowski, Gregory P 955 NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Gregory P.Bonkowski Male Date of Death Age If Veteran of U.S.Armed Forces, 11/24/2023 73 Years War or Dates �._ Place of Death Hospital,Institution or Z City,Town or Village Chester Town Warren Street Address 941 State Route 28N,Chester Town Warren,New York 12853 111 'p Manner of Death Z Natural Cause Accident El Homicide Suicide Undetermined n Pending Circumstances Investigation W Medical Certifier Name Title Ellen Deprey PA Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed Town Of Chester District Number Register Number City,Town or Village 5652 24 Burial Date Cemetery,Crematory or Facility Name 11/28/2023 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York DDonation OZ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 a Date Point of U) Transportation by Common Shipment Carrier Destination oDisinterment Date Cemetery Address n Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom �— Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2023 Registrar of Vital Statistics Mindy Conway(Ehctronicaffy Signed) (signature) District Number 5652 Place Town Of Chester I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition /��'�4C!3. Place of Disposition f:,Ve 2 (address) W N CC (section) (lot numtter) (grave number) Name of Sexton or Person in Charge o Premises Z / q (please print/ W Signature �D Title eie,191.0 iJ— DOH-1555(07/18)p 1 of 2 ,.t 1 -7706 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#