Scheifman, Martin E ",
NEW YORK STATE DEPARTMENT OF HEALTH 4/ 39
Vital Records Section Burial - Transit Permit
Name First Martin Middle Raymond Labcheifman Sex Male
Date of Death Age If Veteran of U.S. Armed Forces,
06/26/2014 88 years War or Dates
j Place of Death Hospital, Institution or
CXX06wn or VXX Greenfield Street Address 70 Hovey Road, Greenfield Center
141
0 Manner of Death❑4glatural Cause ElAccident ElHomicide ElSuicide ❑Undetermined ❑Pending
Ili Circumstances Investigation
ill Medical Certifier Name Title
O Jama L. Peacock- Birsett M D
Addrgi Wilton Road, Greenfield Center, N Y 12833
Death Certificate Filed District Number Register Number
CNAXA6wn or ViNgtaxX Greenfield 4557 7
❑Burial Date Cemetery or Crematory
06/27/2014 Pine View Crematorium
❑Entombment Address
lillii❑cremation Queensbury, New York
Date Place Removed
❑Removal and/or Held
and/or Address
t= Hold
O.
0 Date Point of
cti El Transportation Shipment
a by Common Destination
gill Carrier
El Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care, Inc. 4
Address
It 402 Maple Avenue, Saratoga Springs, N Y12866
iiilili Name of Funeral Firm Making Disposition or to Whom
14. Remains are Shipped, If Other than Above
• Address
IX
tt
.:. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/27/2014 Registrar of Vital Statistics
(signature)
111 District Number 4557 Place Greenfield J
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tf,j
J.Date of Disposition V�3D�l� Place of Disposition i+u Date Cr.,,vto{,w,
2 (address)
til
w
CC (section) J(lot number)( (grave number)
ta▪ Name of Sexton or Perso in Charg of Premises IUHedlyL.. 3/4,14
2 (pldase print)
Signature y Title airs '2
(over)
DOH-1555 (02/2004)