Deyette, William Alexander NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
William Alexander Deyette Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/17/2021 82 Years War or Dates 1956-1960
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 41 Glenwood Avenue,Queensbury Town, New York 12804
W Manner of Death 0 Natural Cause ElAccident ❑Homicide Suicide 0 Undetermined Pending
O Circumstances Investigation
W Medical Certifier Name Title
O Suzanne Blood MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 243
❑Burial Date Cemetery,Crematory or Facility Name
12/23/2021 Pine View Crematory
❑Entombment Address
K❑Cremation Queensbury Town, New York
❑Donation
ORemoval Date Place Removed
and/or and/or Held
H Hold Address
0
a Date Point of
to ❑Transportation
Q by Common Shipment
Carrier Destination
Date Cemetery Address
El Disinterment
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
I}— Remains are Shipped,If Other than Above
2 Address
Q
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/20/2021 Registrar of Vital Statistics Carolinexkfegardi Barder(lectronicallySignerl)
(signature)
District Number 5657 Place Queensbury, 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 /.?,a7-1-p if Place of Disposition ' �e C r-.4014,1v
W
(address)
W
(section) ` (loin tuber (grave,number)
O Name of Sexton or Person in Char of Prem. s ���i�/G'/'t L� l�
Z /please print)
W
Signature Title Qf(r440
DOH-1555(07/18)p t of 2
r .j
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#