Paquette, Joseph NEW YORK STATE DEPARTMENT OF HEALTH r ,t ��'
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Joseph Paquette Male
Date of Death Age If Veteran of U.S. Armed Forces,
July 22,2011 64 War or Dates
. Place of Death Hospital, Institution or
Zd City, Town or Village Hague Street Address 87 Silver Bay Rd.
111
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Al Circumstances Investigation
C.) Medical Certifier Name Title
Gary Scidmore
Address
i 6930 State Rt. 8,Brant Lake,NY 12815
Death Certificate Filed District Number _ Register Number
' City, Town or Village Hague
❑Burial Date Cemetery or Crematory
July 26,2011 Pine View Crematory
El Entombment Address
❑x Cremation Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F" Hold
Cl)
0 Date Point of
co Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
H Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00035
Address
{ 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
I--. Remains are Shipped, If Other than Above
E Address
U
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 17 12.E 12011 Registrar of Vital Statistic ; n f, )
(signature)
District Number N.C)5� Place Hague
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z /�
UJ Date of Disposition 11 n lit Place of Disposition ?NO,t� C.s�.�{.•,,,—
W (address)
CO
re (section) j r .. (I t numbe (grave number)
Q Name of Sexton or Person in Charge of PXemises r►y1•3- ,,..t}
'Z AL
( lease print)
4
Signature Title CQ;;vt+414 (over)
DOH-1555 (02/2004)