Scofield, Joseph R NEW YORK STATE DEPARTMENT OF HEALTHLIF
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Joseph R.Scofield Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/07/2023 61 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Lake Luzerne Town Street Address 124 Scofield Road, Lake Luzerne Town, New York 12846
p Manner of Death FiNatural CausenAccidentomicide Suicide nUndetermined ❑Pending
W 1
U Circumstances Investigation
QW Medical Certifier Name Title
Connie Goedert Coroner
Address
1400 St Route 9, Lake George Town, New York 12845
Death Certificate Filed Town Of Lake Luzerne District Number Register Number
l'H
City,Town or Village 5656 7
Burial Date Cemetery,Crematory or Facility Name
06/10/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town, New York
Donation
0❑Removal Date Place Removed
H and/or and/or Held
N Hold Address
0
CI. Date Point of
N f Transportation
8 by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Brewer Funeral Home Inc 00211
Address
24 Church Street PO Box 500, Lake Luzerne,New York 12846
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
2 Address
CC
UJ
a. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/09/2023 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed)
(signature)
District Number 5656 Place Town Of Lake Luzerne
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
F—
W 'Date of Disposition 6,-fQ ZOL 3 Place of Disposition ie It .1) Cr�I19a-M r3
M (address)
W
N
O (section) (lot number) (grave number)
C Name of Sexton or Person in Char of Pre -se RAl'N jacf
Z please print)
W Signature W7 /bi/ Title U f('Jo let
DOH-i555(07/18)p 1 of 2
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#