Famiano, Diane tf S Z
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section BUPIII _ Transit Permit
Name First Middle Last Sex
Diane Famiano Female
Date of Death Age If Veteran of U.S. Armed Forces,
01 / 1 / 2020 76 War or Dates N/A
}= Place of Death Hospital, Institution or
Z City, Town or Village Saratoga Springs Street Address 59 Vanderbilt Ave.
Manner of Death®Natural Cause Accident Homicide ❑Suicide ❑Undetermined El Pending
Circumstances Investigation
U1 Medical Certifier Name Title
Q John Mongan DO
Address
3 Care Ln #300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Number
City,Town or Village Saratoga Springs i
DBurial Date Cemetery or Crematory
01 / 15 / 2020 Pine View Crematory
Entombment Address
Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp., NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remai des ribed`a�ove s indica ed.
Date Issued 114 1 20� Registrar of Vital Statistics { -
(signature)
s District Number L4 ' Place Saratoga Springs New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
�
/9
Date of Disposition 16 170 Place of Disposition - , Li r-�ra—
(address)
(section) (lot number) (grave number)
0. Name of Sexton or Person 0harge Premises r L
(P(fase punt) .
tu Signature Title ( A I�2
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) J 13 2 4 5
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on,burial permit
Official Funeral Directors Reg.or License#