Deyette, Judith Ann .@ 27 6 g
NEW YORKSTATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Judith Ann Deyette Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/17/2022 83 Years War or Dates
t,., Place of Death Hospital,Institution or
UJ
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death 0 Natural Cause Accident El Homicide OSuicide Undetermined Pending
W
U Circumstances Investigation
Q Medical Certifier Name Title
Melody Long PA
Address
100 Park Street,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 427 r
Burial Date Cemetery,Crematory or Facility Name
®1° 08/18/2022 Pine View Crematory
Entombment gddress
Cremation Queensbury Town,New York
Donation
❑Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
O. Date Point of
V)❑Transportation
G by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
1— Remains are Shipped,If Other than Above
2 Address
CC
W
CL' Permissionis hereby granted to'dispose of the human remains described above as indicated.
Date Issued 08/17/2022 Registrar of Vital Statistics 9l•tegan.Nolin(E(ectronica1rySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition ILI $)1�IV_ Place of DispositionFj_ ZA— _ ,
W (address)
Cl)
LC (section)
(lot number/ (grave number/
Name of Sexton or Person in Charge of Pre ises Al(P 1___ tt
2 ase print)
Ill Signature �P6rn��,�Title
DOH-1555(07/18)p 1 of 2
7
Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on r , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#