Scofield, Denise I NEW YORK STATE DEPARTMENT OF HEALTH Burial -Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Denise I Scofield Female
Date of Death Age If Veteran of US.Armed Forces,
02/15/2023 61 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
LU
p Manner of Death Natural Cause Accident Homicide Ei Suicide El Undetermined Pending
Circumstances Investigation
W Medical Certifier Name Title
a Jeremy Di Bari MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 90
Burial Date Cemetery,Crematory or Facility Name
02/17/2023 Pineview Crematiry
Entombment Address
1k1Cremation Queensbury Town,New York
Donation
• ZO❑Removal Date Place Removed
and/or and/or Held
Hold Address
N
0
o. Date Point of
CO Transportation
ES Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
— Remains are Shipped,If Other than Above
2 Address
lW
Q. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/16/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 21 n 113 Place of Disposition 17 uV �•—�
(address)
W
(section) (lot numbe i (grave number)
0 Name of Sexton or Person in Charge of P ises (',ANlip/e
z �% \ I(Ptease pri
fW Signature Title (far>niive
DOH-1555(o7/18)p id 2
d ,FC f _.
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on • , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#