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Wood, Diane M. NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Diane M.Wood Female Date of Death Age If Veteran of U.S.Armed Forces, 03/22/2020 69 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Hadley Town Street Address 21 Elm Street, Hadley Town, New York 12835 p Mannerof Death ©Natural Cause Accident Homicide Suicide El Undetermined Pending W Circumstances Investigation U W Medical Certifier Name Title Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Hadley 4558 3 ❑Burial Date Cemetery,Crematory or Facility Name 03/24/2020 Pine View Crematory Entombment Address Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held F- Hold Address N O IQ Date Point of U) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500, Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above Address W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/24/2020 Registrar of Vital Statistics Pauline G Smead(Electronically Signed) (signature) District Number 4558 Place Hadley, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Place of Disposition W (address)-.) 2 W N (section) (lot number/ (grave number) G Name of Sexton or Person in Char of Pre 'se OH/� /please print Z W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 13 4 5 8 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#