Loading...
Dubay, Diane Louise LOF NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Diane Louise Dubay Female Date of Death Age If Veteran of U.S.Armed Forces, 01/16/2024 90 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death nUndetermined Pending � �Natural Cause Accident �Homicide Suicide I I � g W Circumstances Investigation LU Medical Certifier Name Title G James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town, New York 12853 Death Certificate Filed Town Of Johnsburg District Number Register Number City,Town or Village 5655 3 ElBurial Date Cemetery,Crematory or Facility Name 01/22/2024 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F Hold Address CO 0 EL Date Point of (I) Transportation EL. Common Shipment Carrier Destination o Disinterment Date Cemetery Address n 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 F. Remains are Shipped,If Other than Above 5 Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/22/2024 Registrar of Vital Statistics Jean M Comstock(ECectronicat(ySigned) (signature) District Number 5655 Place Town Of Johnsburg 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 123174 Place of Disposition gr/474146C-t} 7/61447j124 ._ W 2 (address) W It (section) (lot Jnumber) (grave number) 0 Name of Sexton or Person in Charge P mises fit ` �`^�l z / ase print) / �7 W Signature Title 6 FG 41q u12 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2bj Receipt • Human remains of —___- __ - ___-----___ delivered on _ , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#