Scofield, Marcus C12-6
NEW YORK STATE DEPARTMENT OF HEALTH - •
Vital Records Section Burial - Transit Permit
Name First Midd Last Sex
Markcus Charles Scofield Male
Date of Death Age If Veteran of U.S. Armed Forces,
11/28/2017 60 Years War or Dates Army
Place of Death Hospital, Institution or
City, Town or Village Albany Street Address Albany Medical Center Hospital
Manner of Death X❑Natural Cause ❑Accident E Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Spencer Lord MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City, Town or Village Albany 0101 2624
❑Burial Date Cemetery or Crematory
12/05/2017 Pine a View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
❑Removal and/or ljeliih-
and/or Address
Hold
Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/30/2017 Registrar of Vital Statistics cnanthllesCifespie E(ectronicaRySigned-
(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:
Date of Disposition 121 5 O Place of Disposition
(address)
(section) (lot number) ( (grave number)
Name of Sexton or Person in Charge o remises ; 1 )t»
( lease print) p
Signature Title 6/(�i �
(over)
DOH-1555 (02/2004)