Krawetz, Diana NEW YORK STATE DEPARTMENT OF HEALTH Burial Transit Permit
Vital Records Section
Name First Middle Last Sex, f
Diana D. Krawetz G1,rytµ le
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 23 / 2017 80 War or Dates
} ; Place of Death Hospital, Institution or
City, Town or Village Hadley Street Address 234 Harris Road
0 Manner of Death Watural Cause E Accident 0 Homicide E Suicide 71 Undetermined Pending
Circumstances Investigation
0.
la Medical Certifier Name Title
0 Roberta Miller MD
Address
16 Crimson Oak Ct, Schenectady, NY 12309
Death Certificate Filed District Number Register Number
City,Town or Village Hadley y
Burial Date Cemetery or Crematory LI 03 / 27 / 2017 Pine View Crematory
8 Entombment Address
ECremation Queensbury, NY
Date Place Removed
t❑Removal and/or Held
and/or Address
Hold
O.
Date Point of
•Q Transportation Shipment
C by Common Destination
Carrier
gil
Disinterment Date Cemetery Address
ai
r Q Reinterment Date Cemetery Address
Mi Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
"'3 402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ir
ILI
Permission is hereby granted to dispose of the human re 'ns described above as indicat
: Date Issued 3.c,(. /'7 Registrar of Vital Statistics Lc '�✓�-64_G'
(signature)
' District Number 445-S p Place Hadley , New York
Wi
tio I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
10 Date of Disposition 311.11n Place of Disposition gl,v:d UM wtorw_
(address)
Iiii
III (section) (lot nu ber) (grave number)
/h
Name of Sexton or Person in Charge Premises -. rtl S . t'
Z �J (glee print) .
la
Signature (� Title 1944114��/1-
(over)
DOH-1555 (02/2004)