McDonald, Diane Mary u
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Tran er1uit
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Bureau of Vital Records , \....r )
do
Name First Middle Last Sex
Diane Mary McDonald Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/31/2022 57 Years War or Dates
i_ Place of Death Hospital,Institution or
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City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death EI Natural Cause Accident Homicide ESuicide FTndetermined ri Pending
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U III Circumstances Investigation
I Medical Certifier Name Title
0 Scott Biasetti MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 665
Burial Date Cemetery,Crematory or Facility Name
01/03/2023 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
0❑Removal Date Place Removed
- and/or and/or Held
I—'- Hold Address
CO
0
Date Point of
Cl)LTransportation Shipment
p by Common
Carrier Destination
O
Disinterment
Date Cemetery Address
0 Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
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IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2023 Registrar of Vital Statistics Megan NoCin(ECectronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /
Date of Disposition I',I L3 Place of Disposition "l 'A« +fit.
ess)
CC (section) i(lot number) (grave number/
Name of Sexton or Person in Charge of,Premises /A /I l I
(pse print)
Wz
i Title c
Signature
DOH-1555(o7/18)p 1 of 2
01.655C
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#