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Pfeiffer, Kenneth G NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kenneth G Pfeiffer Male Date of Death Age If Veteran of U.S.Armed Forces, 07/23/2021 66 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Queensbury Town Street Address 16 Queen Ann Court,Queensbury Town, New York 12804 'p Manner of Death ©Natural Cause ElAccident I=1 Homicide ❑Suicide 1=1 Undetermined El Pending Circumstances Investigation W Medical Certifier Name Title 0 George Siniapkin MD Address 604 Palmer Avenue,Corinth Town,New York 12822 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 154 ❑Burial Date Cemetery,Crematory or Facility Name 07/27/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation O• ElRemoval Date Place Removed and/or and/or Held N Hold Address O O. Date Point of t/) ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above S Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/27/2021 Registrar of Vital Statistics Carolinex(Cegardf Barber(ECectronica1TySigned) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition Place of Disposition 1yfL �C.w C,re,A,c 0/ 2 (address) W cc (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premises J t0414, ,S c1-' rt f' Z (please print/ W Signature Title (./<.r►rft r DOH-1555(07/18)p 1 of 2 ‘1("...k Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Kenneth Pfeiffer were cremated on July , 28 20 21 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death July , 23 20 21 Age 66 (Month) (Day) Funeral Home Singleton Sullivan Potter Registered No. 615 Authoriz Signat e) PFEIFFER L � NAME Kenneth G. Pfeiffer Age: 66 Lot Owner: Kenneth G. Pfeiffer Lot# Erie 6 B Grave# 1 Case: Urn Died: 7/23/2021 Interred: 7/30/2021 Funeral Home: Singleton Sullivan Potter Cemetery: Pine View Public Health Law Sec. 4145(2b) 01-4 9 3 3 Receipt Human remains of delivered on , 20 Pine ew Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#