Shuler, Phyllis # -TNNEW YORK STATE DEPARTMENT OF'"K'ALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Phyllis Ann Shuler Female
IV Date of Death Age If Veteran of U.S. Armed Forces,
09/23/2018 70 Years War or Dates
PP
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
deei Manner of Death Le Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
- Medical Certifier ga
Name Title
Courtney Stewart NP
Address
7. 100 Park St,Glens Falls,New York 12801
z. Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 453
❑Burial Date Cemetery or Crematory
Ai 09/25/2018 Pine View Crematory
ar'
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
N
Date Point of
'® ❑Transportation Shipment
by Common Destination
-- Carrier
I ❑Disinterment Date Cemetery Address
•
❑Reinterment Date Cemetery Address
• Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
_.; Remains are Shipped, If Other than Above
5 Address
CC-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/25/2018 Registrar of Vital Statistics MertA Curtis(ECectronicalrySigned)
(signature)
▪ District Number 5601 Place Glens Falls, New York
j I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
U Date of Disposition 9 i to ll Q Place of Disposition i7010—. tr",otor,,�
(address)
i
it (section) i) lot number) J (grave number)
• Name of Sexton or Person in Charge of Premises L r� e^41
/1, p1 e print)
4- Signature L.t ✓G Q" Title kkisol�t
(over)
DOH-1555 (02/2004)