Neeley, Diana NEW YORK STATE DEPARTMENT OF HEALTH MK ft L
Vital Records Section Burial - Transit Permit
7 Name First Middle Last Sex
Diana Neeley Female
Date of Death Age l If Veteran of U.S. Armed Forces,
February 4, 2011 83 j War or Dates Yes 1952-1972
Place of Death Hospital, Institution or
City, Town or Village Glens Falls i Street Address Glens Falls Hospital
tti
es Manner of Death X Natural Cause I I Accident Homicide Suicide Undetermined Pending
LiiCircumstances Investigation
us Medical Certifier Name Title
g; Sean Bain
Address
100 Park St, Glens Falls,NY 12801
: Death Certificate Filed District Number Regist Number
ii City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
February 10, 2011 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
Z I !Removal j and/or Held
and/or Address
F- Hold
N
O Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
[ Reinterment Date Cemetery Address
.vf Permit Issued to Registration Number
Name of Funeral Home Sullivan Minahan & Potter 01675
,, Address
407 Bay Road, Queensbury, NY 12804
N• ame of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
5 A• ddress
re
Id#I
', Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued zj 7/l/ Registrar of Vital Statistics LA. W,
(signal/ )
1/456—
: District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed U l.,ntiof in accordance with this permit on:
W Date of Disposition 1=-3 ii I/o`I Place of Disposition en(01. n.4 Of v ft..-
w (address)
cn
w (section) (lot numbe (grave number)
Q Name of Sexton or Person in Charge Premises a f,SI-
Z 1 (please print)
W
Signature Title CfLiEP9OrT L
(over)
DOH-1555(02/2004)