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McClellan, Bruce Dee 1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Bruce Dee McClellan Male Date of Death Age If Veteran of U.S.Armed Forces, 02/13/2024 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 5 Lakewood Drive,Queensbury Town,New York 12804 p Manner of Death El Natural Cause Accident Homicide Suicide InUndetermined El Pending W Circumstances Investigation W Medical Certifier Name Title C Michael Miles MD Address 38 38 Larose Street,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 27 Burial Date Cemetery,Crematory or Facility Name 02/15/2024 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York DDonation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 O. Date Point of CO) Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment 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 F— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2024 Registrar of Vital Statistics Caroline x(Tegarde Barber g(ectronicauty Signed) (signature) District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition b'Zti Place of Disposition � c.J C'a tnpOjjt,-- 2 (address) W NCC /sectron/ 1 (lot number) (grave number) gName of Sexton or Person in Cha mises /^ L It tease print/ ,r .., W Signature Title ` A mve DOH-1555(07/18)p 1 of 2 1 Public Health Law Sec. 4145(2b) ` t Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#