Pfeiffer, Marie NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vtal Records Section i
.; Name First Middle Last Sex
Marie C. Pfeiffer Female
Date of Death Age If Veteran of U.S.Armed Forces,
F February 12, 2006 51 War or Dates AO?
Z Place of Death Hospital, Institution or
W City, Town, or Village Glens Falls Street Address Glens Falls Hospital
G Manner of Death X❑ Natural Cause n Accident n Homicide ❑Suicide ❑ Undetermined ❑ Pending
ill Circumstances Investigation
0 Medical Certifier Name Title
W Dr. Mark Hoffman, M.D. Dr.
Q Address
420 Glen St, Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 7 3
Burial Date Cemetery or Crematory
February 15, 2006 Pine View Cemetery
❑Entombment Address
a ❑Cremation Quaker Road Queensbury, NY 12804-
Date Place Removed
0 ❑ Removal and/or Held
and/or Address
I' Hold
0 Date Point of
0 ❑Transportation Shipment
O. by Common Destination
Carrier
- Date Cemetery Address
0 ❑ Disinterment
Date Cemetery Address
❑ Reinterment
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 0/6,82.
Address
407 Bay Road, Queensbury, New York 12804
~ Name of Funeral Firm Making Disposition or to Whom
2 Remains are Shipped, If Other than Above
Ce
W Address
0.
Permission is hereby granted to dispose of the human remains desscc "b/ed aabo as i ted.
Date Issued QZ /y/0 6 Registrar of Vital Statistics 2v� �v' .
/ (signature)
District Number l5l/0/ Place Glens Falls,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
2
W Date of Disposition 02/15/2006 Place of Disposition Pine View Cemetery
2 (address)
0 ERIE 6-A 1
0 (section) (lot number) (grave number)
d Name of Sexton or Person in harge of Premises M I CHAEL BEN I ER
W _ (please print)
Signature ,fi Title S U PT.
(over)
DOH-1555 (02/2004)