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Brean, Diane Carol NEW YORK STATE DEPARTMENT OF HEALTH r — Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Diane Carol Brean Female Date of Death Age If Veteran of US.Armed Forces, 03/23/2023 60 Years War or Dates I— Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital WManner of Death Li Natural Cause ❑Accident 0 Homicide nSuicide Undetermined ri Pending V Circumstances Investigation WW Medical Certifier Name Title CL Stephen Offord MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 196 ElBurial Date Cemetery,Crematory or Facility Name 03/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z❑Removal Date Place Removed and/or and/or Held I- - Hold Address N 0 O. Date Point of U) Transportation aby Common Shipment Carrier Destination IDDisinterment 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 E.. Remains are Shipped,If Other than Above 2 Address CC W Cl. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/27/2023 Registrar of Vital Statistics Dillon Moran(ECectronicattySigned) (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— (---, W Date of Disposition 3)3o i Z3 Place of Disposition '1, _ 6` _ 2 (address) W CC N (section) (lot number) (grave number) SName of Sexton or Person in Cha f Premises //,,k..0 L- tt z 7 (p/ease print) W Signature Title CFI <� �I TV( DOH-1555(o7/i8)p 1 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#