Phillips, Mary NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Faith Phillips Female
41 Date of Death Age If Veteran of U.S. Armed Forces,
. 7/6/2018 60 War or Dates
'' Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address 139 South Street Ext.Apt 1
ri
Manner of Death ❑X Natural Cause ❑Accident ❑Homicide pi Suicide 1-1 Undetermined �Pending
Circumstances Investigation
Medical Certifier Name Title
I Tim Murphy,Coroner
Tom;
z. Address
;,"° Glens Falls,NY
Death Certificate Filed District Number Register Number,, ,�
City, Town or Village Glens Falls,NY 5601
El Burial Date Cemetery or Crematory
Entombment July 11,2018 Pine View Crematorium
111 Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
ZO n Removal and/or Held
and/or Address
H Hold
Cl)
O Date Point of
O.
n Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
�„; Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
bi 53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
A Permission is hereb granted to dispose of the hums emain escrib aboovv as indi ated.
Date Issued 0�/J/ ,�/� Registrar of Vital St tistics er.."-€ 7 .�`t�
si9nature
GjCj ( )
ca-*/District Number � � Place
I certify that the remains of the decedent identified above re disposed of in accorda a with this permit on:
L Date of Disposition 11,274 Place of Disposition &V..,� �Y.,7t.••,
(address)
W
CO
te (section) A(lot umber) (grave number)
pName of Sexton or Person in Charge of Premises U1r,d,L _)t-�r
Z � (pl ase print)
LU Signature L,f� 4 Title (ff 1,1.
(over)
DOH-1555(02/2004)