Winchell, Diana # —)ZCt
NEW YORK STATE DEPARTMENT OF HEALTH .� ' '
Vital Records Section Burial - Transit Permit
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g Name First Middle Last Sex
Diana J. Winchell Female
Date of Death Age I If Veteran of U.S. Armed Forces,
September 5,2018 45 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 40A Burdick Avenue
Manner of Death g Natural Cause I I Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Iti Medical Certifier Name Title
Saha Marish Dr.
Address
Family Medicine Of Malta,Ballston Spa,NY 12020
y , Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
September 7,2018 Pine View Crematory
El Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
O and/or Address
- Hold
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0 Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
';r= Permit Issued to Registration Number
:i Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
{{ Address
,' Permission is her by ranted to dispose of the human remains de ribed above as indicated.
Date Issued 9Registrar of Vital Stati . {J,GL.---
(signature)
District Number 5660 Place Warrensburg
1—
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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ui Date of Disposition 4/')II% Place of Disposition 17:cx 0. ei-lo~
2 (address)
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co
CC (section) (lot nu�l er) (grave number)
pName of Sexton or Person in Charge of Premises L/rat L )00.4r
Z (please print)
W Signature �,L-4 Title 626,111-2 L
(over)
DOH-1555 (02/2004)