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Chaudry, Yousaf R NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Yousaf R.Chaudry Male Date of Death Age If Veteran of U.S.Armed Forces, 11/18/2021 71 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Troy Street Address Samaritan Hospital 'p Manner of Death ©Natural Cause El Accident ID Homicide ❑Suicide Undetermined ❑Pending V Circumstances Investigation Medical Certifier Name Title C Alexander Grinshpun MD Address 2215 Burdett Ave,Troy,New York 12180 Death Certificate Filed District Number Register Number City,Town or Village Troy 4102 636 ©Burial Date Cemetery,Crematory or Facility Name 11/24/2021 Pine View Cemetery ❑Entombment Address 12 Cremation Queensbury,New York ❑Donation Z Removal Date Place Removed and/or and/or Held F Hold Address N 0. 1-1 Date Point of pl ❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 2 Address OC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/22/2021 Registrar of Vital Statistics 7featherL MuCinio(ECectronicalySigned) (signature) District Number 4102 Place Troy, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 11 .24 .21 .Place of Disposition 21 Quaker Rd Queensbury, NY 12804 ILI 2 (address) N Horicon 17C 1 i= (section) (lot number) (grave number) 8 Connie Goedert Name of Sexton r Person in Charge Premises Z (please print) W Signature Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012882 Receipt Human remains of _ , , i�; /- delivered on / I - ---I , 20-I Pin ew Cemetery Representing the funeral home Vi e nam on burial permit Official Funeral Directors Reg.or License# i Chaudry NAME Yousaf Chaudrry Age: 71 Lot Owner: Arshad Bhatti Lot# Horicon 17C Grave# 4 Case: Concrete Died: 1 1 . 1 8.21 Interred:1 1 .2 4 .21 Funeral Home: Regan Denny Stafford Cemetery: Pine View