Perkins, Diane e _. * t g2i
NEW YORK STATE DEPARTMENT OF HEALTH ..,. " `Vital Records Section Burial - Transit Permit
VName First Middle Last Sex
r' ; Diane M. Perkins Female _
0fr Date of Death Age If Veteran of U.S. Armed Forces,
fi November 17,2015 72 War or Dates NA
rr Place of Death
k Hospital, Institution or
City, Town or Village Saratoga Springs Street Address Saratoga Hospital
Manner of Death Natural Cause Accident Homicides j Suicide Undetermined Pending
I� Circumstances Investigation
Medical Certifier Name �p1/_I A.
Title /�
r ���(�' 1 l 0� 1/ 1 V .Y I Z r() Fro o �1 c Address C<CJA �� • Cl_ 11I1 J ii. y
Death Certificate Filed District Number ' Register Number
�rr City, Town or Village��' Y 9 Saratoga Springs, NY
❑Burial Date Cemetery or Crematory
El Entombment November 19, 2015 Pine View Crematorium
Address
El Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z, Removal and/or Held
and/or Address
F_-- Hold
ft)'
0 Date Point of
N1 'Transportation Shipment
3 by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
;fir Permit Issued to Registration Number
fi{ Name of Funeral Home Regan& Denny Funeral Home 01444
tiA Address
94 Saratoga Avenue, South Glens Falls,NY 12803 _
Name of Funeral Firm Making Disposition or to Whom
j
Remains are Shipped, If Other than Above
Address
Permission is ere y granted to dispose of the human remains scribed above as indicated.
:Date Issued I I iq 2pt, Registrar of Vital Statistics
sr1 fignat r
District Number l Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z,
W Date of Disposition Il/70/15' Place of Disposition a ii,,,✓ ( to .
2 (address)
W"
):
Le (section) (lot numb ) (grave number)
pName of Sexton or Person in Charge of Premises (4,,, AIAtet
Z lease print)
W /!� 4Signature ' Title f0-744-
(over)
DOH-1555(02/2004)