Edwards, Diane Joyce NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Diane Joyce Edwards Female
Date of Death Age If Veteran of U.S.Armed Forces,
09/26/2021 69 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing
p Manner of Death 0 Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined El Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
0 Jennifer Donovan DO
Address
152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 202
EiBurial Date Cemetery,Crematory or Facility Name
09/30/2021 Pine View Crematory
ElEntombment Address
0 Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
- Hold Address
0
O. Date Point of
U) 11 Transportation Shipment
by Common
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
5 Address
CC
W —
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/29/2021 Registrar of Vital Statistics Caroliinexldegarf Bar6er(Ekctronica(Sgned9
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /�
( L >�
W Date of Disposition q�3�,� Place of Disposition ,,,t l_
2 (address)
W
CC CC (section) (lot number) (grave number)
0 Name of Sexton or Person in Charge of emises
Z �/��,, (pitase print)
C._.�X Title ! A`M 1
Signature
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) ` �`" `` "1,9
Receipt
1
� Human remains of - � - delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#