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Johnson, Dianne Lenore
# Iota NEW YORK STATE DEPARTMENT OF HEALTH --� 1.°(......9r\ _ 'Bureau of Vital RecordsBurial Transit Permit Name First Middle Last Sex Dianne Lenore Johnson Female Date of Death Age If Veteran of U.S.Armed Forces, 12/12/2023 82 Years War or Dates F. Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation O Manner of Death ❑X Natural Cause Accident ❑Homicide El Suicide 111Undetermined ri Pending 111 Circumstances Investigation W• Medical Certifier Name Title O Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 582 Burial Date Cemetery,Crematory or Facility Name 12/13/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of CO 0Transportation p by 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 F. Remains are Shipped,If Other than Above 2 Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/13/2023 Registrar of Vital Statistics Megan No(in(E(ectronicaly 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: Z W Date of Disposition 12 "(�is- Place of Disposition FTilEvz6 L.11 C{�.4r44iV�'L , +'........ 2 (address) W Q (section) (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premises �'.i �- i4 (p% se print) ▪ Signature �M 2Title 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#