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Golden, Diane M t . # ti? NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records : Name First Middle Last Sex ti Diane M.Golden Female Date of Death Age If Veteran of U.S.Armed Forces, 01/18/2022 79 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Thurman Town Street Address 675 Garnet Lake Road,Thurman Town,New York 12885 p Manner of Death ©Natural Cause I=1 Accident I=I Homicide ❑Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Jaime Bickford DO :," Address x. 315 S.Manning Boulevard,Albany,New York 12208 '; Death Certificate Filed District Number Register Number ,," City,Town or Village Albany 8888 ❑Burial Date Cemetery,Crematory or Facility Name 01/21/2022 Pine View Crematory ❑Entombment Address 0 Cremation Queensbury Town,New York ❑Donation Z Removal Date Place Removed O and/or Held F� and/or CO Address 0 Date Point of U) Transportation Shipment p by Common Carrier Destination Date Cemetery Address ElDisinterment El Reinterment Date Cemetery Address z=` Permit Issued to Registration Number 3� Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address CC G Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/21/2022 Registrar of Vital Statistics StephanieE.Ostrowski,(E(ectronicalTySigned) (signature) District Number 8888 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- Z Date of Disposition I i Zl I 7 Place of Disposition V` n— W (a r w�dress) Ei) to dot number) (grave number) S (section) ///Ah Name of Sexton or Person in Charge of Premises as AAA Itr (pleasorint/ z (fr�rn KT W Signature Title DOH-1555(07/18)p 1 of 2 (1 1_5572 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# y