Duquesnel, Yvonne N NEW YORK STATE DEPARTMENT OF HEALTH @BUrlal - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Yvonne N Duquesnel Female
Date of Death 1 Age If Veteran of U.S.Armed Forces,
05/03/2022 93 Years War or Dates
i_ Place of Death Hospital,Institution or
pZ City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
Manner of Death
Natural Cause Accident Homicide OSuicide Undetermined Pending
W U Circumstances Investigation
LIJ G Medical Certifier Name Title
Joshua Starteri NP
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 23
X Burial Date Cemetery,Crematory or Facility Name
.1 05/16/2022 Pine View Cemetery
Entombment
_ Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
d Date Point of
N EITransportation
CI 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
F— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/10/2022 Registrar of Vital Statistics Sheliey.Mckgmon(ECectronica1TySigned)
(signature)
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
IH 5/o c9 /'Z Date of Disposition . (2Q Place of Disposition / f'UQ/fX I1 L 4,/,Ci,,5 r 67 1<Y50/
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2 (address)
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VI
Q (section) (lot number) (grave number)
0 Name of Sexton Person in Charge of P ises 7 GTie
Z = (please print)
W Signature .df-k'Ee e '1i,„ Title .-r/i /'7Ckfrc2-
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DOH-1555(07/18)pi of 2
Public Health Law Sec. 4145(2b)
Receipt
1 , i
Human remains of "\ ,.. ,!, _ . + ` ' delivered on ', i i 1 ' , 20 I
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''Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#
DUQUESNEL
NAME Yvonne nn Duquesnel Age: 93
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Lot Owner: Yvonne Duquesnel
Lot# Erie 41 E Grave
Case: Concrete
Died: 5/3/22 Interred: 5/1 6/2 2
Funeral Home: Regan Denny Staff ford
Cemetery: Pine View
DesL
Owner
Yvonne DUquesnel
Address Plot
1 Sparrow Hawk Circle, Halfmoon, NY 12065 Erie
Phone # •
Lot #
518-744-8006 41E
Deed # Date
4307 1 .28.22
Cost Foundation Y - N
$650.00
Location West-Vacant
East-Steele
South-Vacant
North-Path
Remarks
I ACKNOWLEDGE THE RECIEPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATTURE: �� f/X DATE: c)U
SIGNATURE: DATE:
Record of Interments
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