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Purner, Diane Carol NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Diane Carol Purner Female Date of Death Age If Veteran of U.S.Armed Forces, 11/25/2021 78 Years War or Dates l.. Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital Undetermined Pending W Manner of Death ©Natural Cause �Accident Homicide �Suicide El Circumstances Investigation W Medical Certifier Name Title CI Peter Pevzner Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2932 ❑Burial Date Cemetery,Crematory or Facility Name 11/30/2021 Pine View Crematorium ❑Entombment Address ElCremation Queensbury Town,New York Donation Removal Date Place Removed - El and/or and/or Held H Hold Address N 0 G. Date Point of (/) Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom ▪ Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/29/2021 Registrar of Vital Statistics cDanielT S GiCCespie(E(ectronicafry Signed) (signature) District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: h— Z Date of Disposition /�-3-Z(Zt Place of Disposition et Ale �� hr�rvt6, W 2 (address) W CC cc (section) (lot number) (grave number) 8 Name of Sexton or Person in Ch e of Pre is " rn m,J cI i)o Z (please print) W Signature Title aee-' DOH-1555(07/18)p 1 of 2 V 1538 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#