Bethel, LaDonna Diane t �
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
LaDonna Diane Bethel # Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/09/2020 65 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
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p Mannerof Death Natural Cause Accident 1:1Homicide Suicide 1:1Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Kevin Allan MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0066
Burial Date Cemetery,Crematory or Facility Name
01/13/2020 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Date Place Removed
O Removal
and/or and/or Held
~ Hold Address
O
IL Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
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Disinterment
Date Cemetery Address
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Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan&Denny Funeral Service 01444
Address
94 Saratoga Ave,S Glens Falls,New York 12804
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped,If Other than Above
Address
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9' Permission is hereby granted to dispose of the human remains described above as indicated. j
Date Issued 01/13/2020 Registrar of Vital Statistics rDanrelfe.Sy'k&pre(E&tmnicalfyS0=4
(signature/
District Number 0101 Place
Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition 1115 IZO Place of Disposition
u) (address)
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N (section) (lot number) - (grave number) i
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Name of Sexton or Person in Charge of Premis �-
r ease print/
Z �J
W Signature LLL���yyy Title I
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DO H-1555(07/18)p 1 of z
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Public Health Law Sec. 4145(2b) 013236
Receipt
Human remains of delivered on , 20�
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#