Plaff, Regina i005
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Regina Pfaff Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/24/2021 51 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
p Manner of Death NI Natural Cause Accident Homicide Suicide �Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
Rafeh Safdar
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2917
Burial Date Cemetery,Crematory or Facility Name
11/27/2021 Pine View Crematorium
Entombment Address
Cremation Queensbury Hamlet,New York
ElDonation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
�- Date Point of
N ❑Transportation
a by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
EjReinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141
Address
9 Pine St,Chestertown,New York 12817
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
a Address
CC
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/26/2021 Registrar of Vital Statistics Oaniefli S Gillespie(ECectronicalySigned)
/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 //—a9-.?'2( Place of Disposition Roe ix e i , j Str
(address)
W
(section) (lumber) (grave number)
gName of Sexton or Person in Charge remi s 1�F�e�o, i �A
(please print)
W Signature Title 0,04-
DOH-t555(o7/18)p t of 2
.• J1..927
Public Health Law Sec. 4145(2b)
Receipt
I
1 -
Human remains of j delivered on • , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# °.