Riffle, Brenda L. (2) NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Brenda L Riffle Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/15/2020 47 Years War or Dates
I,— Place of Death Hospital,Institution or
WCity,Town or Village Albany Street Address St Peters Hospital
p Manner of Death El Natural Cause Accident Homicide Suicide El Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
Javid Saifi MD
Address
315 S Manning Blvd,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 0592
Burial Date Cemetery,Crematory or Facility Name
03/18/2020 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO ❑Removal Date Place Removed
and/or and/or Held
I—N Hold Address
(L Date Point of
U) Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
l.— Remains are Shipped,If Other than Above
% Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/17/2020 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
Z Date of Disposition j/ — Z Place of Disposition /— N
W ess)
2
W
N /sedan) /iot umb r) (gravenumber)
G Name of Sexton or Person in Ch a of Pre mi s ) �`
(please print)
Z
W Signature Title
DOH-1555(o7/18)p 1 of 2
t 1
Public Health Law Sec. 4145(2b) - - �-3 4 ° <
Receipt
t
Human remains of delivered on/V' 20
Pine View Cemetery -I ting the funeral home named on burial permit
Official Funeral Directors Reg.or License#—/