Emanuelson, Diane NEW YORK STATE DEPARTMENT OF HEALTH 1
Vital Records Section Burial - Transit Permit,
Name First Middle Last Sex
Zit
Diane A Emanuelson Female
• Date of Death Age If Veteran of U.S. Armed Forces,
" 12/07/2018 88 Years War or Dates
`.., Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Wesley Health Care Center Inc
` Manner of Death Natural Cause D Accident 0 Homicide Suicide �Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Eric Santell NP
Address
131 Lawrence St,Saratoga Springs,New York 12866
Death Certificate Filed District Number Register Number
City, Town or Village Saratoga Springs 4501 644
❑BUrial
Date Cemetery or Crematory
12/10/2018 Pine View Crematorium
❑Entombment Address
Cremation Queensbury Town, New York
Date Place Removed
z• ' ri Removal and/or Held
and/or Hold Address
CO
Q Date Point of
AD Transportation Shipment
by Common Destination
Carrier
y ❑Disinterment Date Cemetery Address
row EliReinterment Date Cemetery Address
P
Permit Issued to Registration Number
,. Name of Funeral Home Carleton Funeral Home Inc 00281
Address
• 68 Main Stpo Box 67,Hudson Falls,New York 12839
;,
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 remains described above as indicated.
Date Issued 12/10/2018 Registrar of Vital Statistics jofin p Franck ElectronicaffySigned)
(signature)
District Number 4501 Place Saratoga Springs, New York
41
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
03 Date of Disposition—/?.—ly Place of Disposition Pine, UAL,,,,) Gre, `t` c ry
(address)
0
i (section) (lot number) (grave number)
pName of Sexton or Person in Charge of Premises Je,CTtY Sq.,icLS
z (please print)
Signature Title GTea - r
(over)
DOH-1555 (02/2004)