Diehl, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH icr6
Vital Records Section Burial - Transit Permi
77,.:. Name First Middle ` Last Sex
Dorothy Diehl Female
Date of Death Age If Veteran of U.S. Armed Forces,
March 11, 2012 87 War or Dates
F. Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
LUp Manner of Death X Natural Cause Accident n Homicide Suicide Undetermined Pending
tU Circumstances Investigation
tis v Medical Ce fier ame Title
Address
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' Death Certificate Filed I District Number Register Number
City, Town or Village Glens Falls,NY 1 5601 1 1 q
❑Burial Date Cemetery or Crematory
March 14, 2012 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date I Place Removed
Z Removal 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
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
+le* Remains are Shipped, If Other than Above
2 Address
et' Permission is hereby granted to dispose of the human remains described bove as ' i ated.
Date Issued 63 3 1.E�/L Registrar of Vital Statistics /G /�<
/ (signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 3-is^ 7c tL Place of Disposition Pine u;€kj Cre vr14:toi^:ki
2 (address)
W
CO
0' (section i (lot number) (grave number)
QName of Sexton or Person in Charg of Premises ( iwi0 k .y i3wv,elk
Z �� (please print)
W Title ,n ACS I r
Signature �.. � �('e Q yr
(over)
DOH-1555(02/2004)