Dinal, Daryle NEW YORK STATE DEPARTMENT OF HEALTH - ', l
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Daryle Ann Dinal Female
Date of Death Age If Veteran of U.S. Armed Forces,
12 / 20 / 2016 71 War or Dates N/A
-- Place of Death Hospital, Institution or
City, Town or Village Saratoga Springs Street Address 3 Lamplighter Lane
a Manner of Death12_7' Natural Cause Accident 0 Homicide �Suicide ❑ Undetermined �Pending
Circumstances Investigation
Ca
la Medical Certifier Name Title
0 John Delmonte MD
Address
3 Care Ln Suite 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number �50) Register Number
City, Town or Village Saratoga Springs (Qn0
<1 nBurial Date Cemetery or Crematory
12 / 22 / 2016 Pine View Crematory
n Entombment iiiiii Address
mii 2Cremation Queensbury, NY
Date Place Removed
2 ri❑Removal and/or Held
and/or Address
,, Hold
Date Point of
❑Transportation Shipment
ta by Common Destination
Carrier
Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
i[ Permit Issued to Registration Number
la Name of Funeral Home Compassionate Funeral Care 00364
iiiiii 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
2 Address
Cr
Iu
" Permission is hereby granted to dispose of the human rema' or" ed<; ab"
r indicat .
Date Issued I1(f Registrar of Vital Statistics �
(signature)
Mii
iiM District Number 1.15D1 Place Saratoga Springs , New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
t Date of Disposition i3/23//G Place of Disposition /7 ne, L.);- C/Cya4,h•/
12 (address'
fn
at (section) /� (lot number) (grave number)
0 Name of Sexto or, son in Charge of Premises —.)� 1 a✓i (9e,✓nG�i�C'_
(please print) •
1!. Signature / i Title -re tea--1
(over)
DOH-1555 (02/2004)