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Combs, Dianne Hazel NEW YORK STATE DEPARTMENT OF HEALTH — Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dianne Hazel Combs Female Date of Death Age If Veteran of U.S.Armed Forces, 11/12/2021 61 Years War or Dates i.. Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address 11 Bacon 3,Glens Falls,New York 12801 Manner of Death ©Natural Cause Accident Ej Homicide El Suicide El Undetermined ❑Pending W U Circumstances Investigation WG] Medical Certifier Name Title Timothy Murphy Coroner Address 52 Haviland Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 513 ElBurial Date Cemetery,Crematory or Facility Name 11/15/2021 Pine View Crematory El Entombment Address ElCremation Queensbury Town,New York ElDonation EiRemoval Date Place Removed H and/or and/or Held N Hold Address 0 a. Date Point of coLi Transportation ES by Common Shipment 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 �-- Remains are Shipped,If Other than Above Address CC W Q' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/15/2021 Registrar of Vital Statistics `RQ6ert Andrew Curtis(ECectronicatTySigned) /signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z � W Date of Disposition j j j Ib tzl Place of Disposition 2 (address W (I) CC (section) (lot number) (grave number) Name of Sexton or Person in Charge of Pre ' es /1 t, �Q�..- cti^A tr Z (pie a print)LU -�� Signature Title �� " l V 1� DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Aar