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Brilling Jr., Phillip Joseph NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Phillip Joseph Brilling Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 11/08/2019 98 Years War or Dates F— Place of Death Hospital,Institution or WCity,Town or Village South Glens Falls Village Street Address 3 Catherine Street,South Glens Falls Village,New York 12803 C) Manner of Death DO Natural Cause Accident Homicide Suicide Undetermined Pending Lij Circumstances Investigation U W Medical Certifier Name Title Joseph Mi hind ukulasuriya MD Address 20 Murray Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 77 ©Burial Date Cemetery,Crematory or Facility Name 11/29/2019 Pine View Cemetery Entombment , ---- -----------— ---- — -- Address -------------- — ----- ❑Cremation Queensbury Town,New York ❑Donation z Removal Date Place Removed and/or and/or Held ~ Hold Address N O 0- Date Point of N Transportation Q by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom �— Remains are Shipped,If Other than Above Address Q tit — --------— —--- a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/18/2019 Registrar of Vital Statistics Shannon&Ifeher(IE,CectronicaCCySigned) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: -- -- Date of Disposition Place of Disposition — ,2� QfECL�2£J N✓✓ ,� J— 4�cidiess/ wCA CA (Sects' (lot number)_ (grave number) 0 Name of Septor Person in Char a of Premises �K. E�E�� Z _ /please riot) tL Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 0 3 5 n-w Receipt s Human remains of ` j ' `'�r �� `delivered on L j ,. �.- r , 201_ Oe View Cemetery Representing the funeral home named o burial permit fficial Funeral Directors Reg.or License#� i - — i i i Brilling NAME PhillipBrilling Jr. Age: 98 Lot Owner: Phillip Brilling Lot# Grave# Uncas 22/455 Case: Concrete Died: 1 1 /8/2 01 9 Interred:1 1 /2 9/2 01 9 Funeral Home: MB Kilmer SGF Cemetery:Pine VIew i i i I