Paquette, Donald George ULF 7s-1
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Donald George Paquette Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/20/2022 67 Years War or Dates
Place of Death s ital,Institution or
Z City,Town or Village Glens Falls Address Glens Falls Hospital
W
p Manner of Death ❑X Natural Cause IllAccident Homicide OSuicide ElUndetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
Shahid Ahmed MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 486
Burial Date Cemetery,Crematory or Facility Name
09/22/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
DDonation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
CI. Date Point of
N Transportation
al Common Shipment
Carrier Destination
O
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
Remains are Shipped,If Other than Above
2 Address
Q
W
D. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/22/2022 Registrar of Vital Statistics JKeganNo1in(EhctronicaffySigned)
(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:
Z
W Date of Disposition 1 I7.317L Place of Disposition
2 (address)
W
N
CC (section) /lot number/ (grave number)
si,
Name of Sexton or Person in Charge of Premi es ��Ct
Z (pi use print)
tU g _ _Signature Title fireoarkt
Prey
DOH-1555(07/18)p 1 of 2
i
1 " g
i "
Public Health Law Sec. 4145(2b)
Receipt
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#