Gaudier, Yvonne NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Yvonne Gaudier Female
Date of Death Age If Veteran of U.S.Armed Forces,
07/19/2021 101 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 198 Bluebird Road,Moreau Town,New York 12803
,p Manner of Death 11 Natural Cause ❑Accident El Homicide Suicide El Undetermined El Pending
Circumstances Investigation
LIJ D Medical Certifier Name Title
Madison Zuis NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 37
ElBurial Date Cemetery,Crematory or Facility Name
07/22/2021 Pine View Crematory
Entombment Address
lCremation Queensbury Town,New York
Donation
ElRemoval Date Place Removed
and/or and/or Held
to Hold Address
0
Date Point of
ff) ❑Transportation
p by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment 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
5 Address
CC
ILI
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/22/2021 Registrar of Vital Statistics Leeann!fcca6e(E'lectronicallyytgned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 7,L-�a6,l Place of Disposition eit)e v (ti,m1. j 1.
2 /address,L
cc to
(section) (lot number) (grave number)
8 Name of Sexton or Person in Char of Premise ' fe/i/Aftd Lavoel
(pease print)
W Signature Title /�p�(fl
DOH-1555(07/18)p t of 2 '�UU
Public Health Law Sec. 4145(2b) ° ` ,4 9 6..
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral$ome named on burial permit
Official Funeral Directors Reg.or License#