Pfeil, Beverly 4 gib
NEW YORK STATE DEPARTMENT OF HEALTH 4
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Beverly L. Pfeil Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 4,2018 76 War or Dates
Place of Death Hospital, Institution or
Z` City, Town or Village Glens Falls Street Address Glens Falls Hospital
::° Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
US Circumstances Investigation
w Medical Certifier Name Title
0 Michael R.Bell
Address
Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village 5 60 1 U( c<�
❑Burial Date Cemetery or Crematory
October 11,2018 Pine View Crematory
0 Entombment Address
II Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9 and/or Address
H Hold
co
0 Date I Point of
O.
Transportation 1 Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
1... Remains are Shipped, If Other than Above
Address
W.
LU-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued I 0. jut 1% Registrar of Vital Statistics LA_
(si nature)
District Number 560 i Place 6 tsGA„S- a\s7 t y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition JD lltii$ Place of Disposition f edq-. lrco+F�
2 (address)
W
co
Ct
(section) (lot tuber) (grave number)
QS
1
Name of Sexton or Person in Charge of Premises (r•i 01A VYV
Z (please pint)
w Signature 4 Title W %714
(over)
DOH-1555 (02/2004)