Nelson, Diane 1
it Z1
NEW YORK STATE DEPARTMENT OF HEALTH B - e5
Vital Records Section BurialTransit Permit
Name First Middle Last Sex
DIANE NELSON FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
3/23/2017 70 War or Dates
I- Place of Death Hospital, Institution
Z City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
p,' Manner of Death pri Natural ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
[; Cause Circumstances Investigation
W—Medical Certifier Name Title
A KEEGAN COLE MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number ' Register Number
City,Town or Village City of Albany 101 688
Date Cemetery or Crematory
0 Burial 3/28/2017 PINE VIEW CREMATORY
❑ Entombment Address
►4 Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q ❑ and/or Address
- Hold
V)
0 Date Point of
n. Transportation Shipment
to ❑ By Common Destination
Cl Carrier
—~ Date Cemetery Address
0
Disinterment
Date Cemetery Address
❑
Reinterment
Permit Issued To Registration Number
Name of Funeral Home ALEXANDER BAKER FH 00037
Address ��
3809 MAIN ST WARRENSBURGH NY 12885
Name of Funeral Firm Making Disposition or to Whom
}y' Remains are Shipped, If Other than Above
2 AddressCe
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0-, Permission is hereby granted to dispose of the human remains descr b d ab ve as in \, at .
Date 3/28/2017 iRegistrar of Vital Stati
stics t
Issued (Sig ature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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Date of Disposition (4 s3 h17 Place of Disposition "1"'t ft1/4) C ^"
n 4eTvsiik
tU (address)
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0 (section) (lot number) (grave number)
0
w Name of Sexton or Person in Charge of Premis 1 4ti ct.11f
(please print)
Signature L{ Title 11 PIAPitt_
(over)
DOH-1555(02/2004)