Abbatantuono, Diane NEW YORK STATE DEPARTMENT OF HEALTH A I It" 2 L c
Vital Records Section Burial - Transit Permit
71 Name First Middle Last r Sex
Diane Abbatantuono Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 21, 2012 64 War or Dates
iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
ili Manner of Death n Natural Cause n Accident 0 Homicide n Suicide n Undetermined Pending
Ui Circumstances Investigation
? Medical Certifier Name Title
P.' Christopher Hoy,MD
Address
Park Street,Glens Falls,NY
Death Certificate Filed District Number Rent tuber
;.:1 City, Town or Village Glens Falls 5601
❑Burial Date Cemetery or Crematory
❑Entombment May 23,2012 Pine View Crematorium
Address
®Cremation 21 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
F' Hold
to
0 Date Point of
N n Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
`'T Permit Issued to Registration Number
is Name of Funeral Home Regan& Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
:: Name of Funeral Firm Making Disposition or to Whom
M Remains are Shipped, If Other than Above
S' Address
Ili
Ai
Permission is hereby granted to dispose of the human remains descri ed ab ve in
z_1.
Date Issued 0S �1�--Registrar of Vital Statistics �
(signature)
A:; District Number 5601 Place Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z 1 U Crert
W Date of Disposition Sl i3 l i t Place of Disposition i� �w cri.•—
(address)
W
tY (section) — (lot number( (grave number)
pName of Sexton or Person in Charge f Premises a(A L-- J(kr*
Z (please print)
WAV Signature Title Cal h1 f*tO&.-
(over)
DOH-1555(02/2004)