Sauter, Diana t x G Z4
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial Transit Permit
Name First Middle Last Sex
Diana Sauter Female
Date of Death Age If Veteran of U.S. Armed Forces,
07/29/2018 88 Years War or Dates
Place of Death Hospital, Institution or
1. City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
Manner of Death Q Natural Cause ❑Accident ❑Homicide Suicide ri❑undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Lori Killon PA
Address
-,ir, 152 Sherman Ave,Queensbury Town,New York 12801
Fq r Death Certificate Filed District Number Register Number
City, Town or Village Queensbury 5657 104
❑Burial Date Cemetery or Crematory
07/31/2018 Pine View Crematory
,_ ❑Entombment Address
®Cremation Queensbury Town, New York
{ Date Place Removed
i
❑Removal and/or Held
and/or Address
, Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier _
❑Disinterment Date Cemetery Address
�r,
❑Reinterment Date Cemetery Address
t . Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
is Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Ii
s
} Permission is hereby granted to dispose of the human remains described above as indicated.
i Date Issued 07/31/2018 Registrar of Vital Statistics Caroline If Barber(E(ectronica((ySigned)
(signature)
District Number 5657 Place Queensbury, New York
; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition gJz(d Place of Disposition et ., lr
(address)
ro
(section) (lott tuber) ( (grave number)
fi. Name of Sexton or Person in Charge of Premises AIL .Jtw (
T
(please rint)
Signature L4 Title AJ`14ik
(over)
DOH-1555 (02/2004)