Younes, Jami L NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jami L.Younes Female
Date of Death Age If Veteran of U.S.Armed Forces,
05/15/2023 48 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 262A Burke Drive,Queensbury Town, New York 12804
p Manner of Death El Natural Cause Accident 111 Homicide Suicide Undetermined ri Pending
W C.) Circumstances Investigation
W Medical Certifier Name Title
O Sean Campanie NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 76
Burial Date Cemetery,Crematory or Facility Name
05/17/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0 Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
(1)❑Transportation
by Common Shipment
Carrier Destination
O
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
H Remains are Shipped,If Other than Above
a Address
Cr
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/17/2023 Registrar of Vital Statistics Caroline Nikregarde Barber(Electronica4 Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 3-1i"/Z3 Place of Disposition
2 (address)
W
N (section) (!ot number/ (grave number)
`
S Name of Sexton or Person in Charge of Premises t"✓ �. ft
lease print/ �(,,��
W Signature C� Title /�'r""�
DOH-1555(07/18)p 1 of 2
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#