Schleifman, Jeanette NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jeanette Schleifman Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2021 94 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Greenfield Town Street Address 70 Hovey Road,Greenfield Town,New York 12833
p Manner of Death ❑X Natural Cause ❑Accident ❑Homicide Suicide ❑Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
CI Susan Muller MD
Address
510 Geyser Road,Ballston Spa Village,New York 12020
Death Certificate Filed District Number Register Number
City,Town or Village Greenfield Center 4557 30
❑Burial Date Cemetery,Crematory or Facility Name
11/10/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
❑Donation
0 Removal Date Place Removed
and/or and/or Held
~ Ho
N ld Address
0
d Date Point of
• Transportation
El Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
ElReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
IX
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2021 Registrar of Vital Statistics Louise okonrew.rki(iElectronrca(Stgnet9
(signature)
District Number 4557 Place Greenfield Center, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition //-/ f-tpt 1 Place of Disposition *Pi,le (Ate-iv Crern
2 (address)
W
CC
CC (section) (lot number) (grave number)
gm of Sexton or Person in Charge f Premises � Yl14'rf d 14/0D�
(please print)
111 Signature Title Orel.t 4-0-r"
DOH-355(07/18)p i of 2
J
4 �
Public Health Law Sec. 4145(2b) ""
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on bur al..permit
Official Funeral Directors Reg.or License# ' j -