Loading...
Paquette, Gail Ann I66 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gail Ann Paquette Female Date of Death Age If Veteran of U.S.Armed Forces, 02/21/2022 66 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address HAYNES House of Hope W Manner of Death Undetermined Pending W © Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title L3 Robert Southerland MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Granville 5756 12 ▪Burial Date Cemetery,Crematory or Facility Name 02/22/2022 Pine View Crematorium ❑Entombment Address O Cremation Queensbury Town,New York EiDonation Removal Date Place Removed and/or and/or Held - Hold Address to 0 O. Date Point of (/) ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address Q W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/22/2022 Registrar of Vital Statistics Jenny Linda M gvtarte1Te(ECectronicaCCy Signed) (signature) District Number 5756 Place Granville, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z � r, W Date of Disposition JZ,lit Place of Disposition 1' d ViT 4°1611.-- (address/ W C (section) Jot number) 3�'1 (grave number) 0• Name of Sexton or Person in Charge Premises r:� -- '►� Z (pieaseint) . fi W Signature Title Xti It iti(1 DOH-1555{07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Y�81_2 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#