Guyette, Richard Arthur 1 33
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Richard Arthur Guyette I Male
Date of Death Age If Veteran of US.Armed Forces,
01/08/2020 78 Years War or Dates 1959-1962
I— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Scott Biasettl MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 18
Burial Date Cemetery,Crematory or Facility Name
01/10/2020 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
z Removal Date Place Removed
and/or Held
E and/or- Hold Address
N
Date Point of
Transportation Shipment
S by Common
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
ElReinterment
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
IW
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/09/2020 Registrar of Vital Statistics RpSkrt,Vrtdrew Cures(EfectrnnrcadySon4
(signature/
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: A
ZW Date of Disposition � Ip 20 Place of Disposition 01..J f�-
(address)
W
N /section/ 11 /iot number/ /grave number/
8 Name of Sexton or Person in Charge Premises A�sepri,7
Aa' � -a
W Signature Title
DOH-1555(o7/18)p 1 of 2
Public Health Law Sec. 4145(2b) 0-.3 2 2 7
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#