Doyle, Diana NEW YORK STATE DEPARTMENT OF HEALTH " 1 # 8 8
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Diana Marie Doyle Female
Date of Death Age If Veteran of U.S. Armed Forces,
December 13, 2016 65 War or Dates
F- Place of Death Hospital, Institution or
W-
City, Town or Village Queensbury Street Address 8 Belle Avenue
Manner of Death ❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
W Circumstances Investigation
W Medical Certifier Name Title
0
Address
Dea ate Filed Di trict Number Rp ister Number
Ci , Town or Village ( (Ak.PLPPSb Cat
❑Burial Date Cemetery or Crematory
December 15, 201 Pine View Crematorium
❑Entombment Address
❑C Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
and/or Address
H Hold Pine View Crematorium
CO Date Point of
00. ❑Transportation Shipment
(I) by Common Destination
p Carrier
Date Cemetery Address
El Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
I-- Remains are Shipped, If Other than Above
2i Address
fe
W
II Permission is hereby granted to dispose of the human r ins described bo a as indicated.
Date Issued W 1S 1(o Registrar of Vital Statistics C .... Q r (k,�
(signature)
District Number SZ.Oc'7 Place 16 04 (Al L{-e_Q-rS
▪ I certify that the remains of the decedent identified above were disposed of in a ordan e with this permit on:
W' Date of Disposition 12/1 2016 Place of Disposition Quaker Road Queensbury,NY 12804 i-h rek) Gee,' 9
2 (address)
W
Cl)
r/ (section) 1 (lot nu ber) f (grave number)
pName of Sexton P i har of Premises " ��/ -✓<' < ✓16-er'`G
(please print)
W Signature Title C.,/e//44 l).�
(over)
DOH-1555 (02/2004)