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Bush, Donald E
OD ,,--6, NEW YORKSTATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle - Last Sex Donald E Bush Male Date of Death Age If Veteran of US.Armed Forces, 01/13/2024 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Wilton Town Street Address 97 Pyramid Pines,Wilton Town,New York 12866 LU O Manner of Death M Natural Cause Accident Homicide Suicide Undetermined ❑Pending LU Circumstances Investigation W Medical Certifier Name Title O John Mongan DO Address 3 Care Lane 300,Saratoga Springs,New York 12866 Death Certificate Filed Town Of Wilton District Number Register Number City,Town or Village 4569 6 EBurial Date Cemetery,Crematory or Facility Name 01/17/2024 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ❑Removal Date Place Removed and/or and/or Held t— Hold Address co (ip❑Transportation Date Point of 0 by Common Shipment Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom N Remains are Shipped,If Other than Above IAddress W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/16/2024 Registrar of Vital Statistics Susan Baldwin(Electronically Signed) (signature) District Number 4569 Place Town Of Wilton I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition I in t Z'I Place of Disposition ?Jr E✓/F.✓ CP'r> -- 11,1 2 (address) W N CC (section) 1 (lot number) (grave number) 70 ::: ° or Person in Cha f Premises Title DOH-1555(07/18)p 1 of 2 F 6 1., 7 9 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# -