Lovering, Diane NEW YORK STATE DEPARTMENT OF HEALTH c '' I /
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Vital Records Section Burial - Transit Permit
9 Name First Middle i Last Sex
• Diane Theresa Lovering Female
Date of Death Age If Veteran of U.S. Armed Forces,
F November 3. 2006 53 War or Dates
Z Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street AddressGlens Falls Hospital
G Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
O Medical Certifier Name Title
W Dr. Orlando J. Martelo, M.D. Dr.
0 Address
102 Park St., Glens Falls, NY 12801
NDeath Certificate Filed District Number Register Number
City, Town or Village Glens Falls _ 5`�
Date Cemetery or Crematory
❑ Burial November "r, 2006 Pine View Crematorium
Address
❑x Cremation Quaker Road Oueensburv, NY 12804-
Date Place Removed
a ❑ Removal and/or Held
- and/or Address
Hold
0 Date Point of
4 ❑Transportation Shipment
L by Common Destination
0 Carrier
Date Cemetery Address
O ❑ Disinterment
El Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00283
Address
1_ 68 Main St., P. O. Box 67, Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
a Remains are Shipped, If Other than Above
w Address
C.
Permission is her y anted to dispose of the human re ins de cribed atve as Indic ed.
Date Issued Registrar of Vital Statistics /71, 1 l'e___
signature)
District Number 5/, / Place Glens Falls,New Yo k
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
w Date of Disposition It /7/oh Place of Disposition 9,tv kL .' re'r j v
i
(address) i
W
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It (section) , (lot number) (grave number)
zZ Name of Sexton 7 Person in Charge of Premises L I,c-,S n I'
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Signature L Title C. c-.•,,._tc r