Carpenter, Philip NEW YORK STATE DEPARTMENT OF HEALTH 0, • % 1/ !
Vital Records Section Burial - Transit Permit
:° Name First Middle Last Sex
Philip D. Carpenter Male
: Date of Death Age If Veteran of U.S. Armed Forces,
e: March 18,2018 80 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Thurman Street Address 45 River Road
Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined n Pending
:0] Circumstances Investigation
us Medical Certifier Name Title
P.,:, T. Coppens
d •; Address
::? One Iron Gate Center,Glens Falls,NY 12801
r.;° Death Certificate Filed District Number Register Number
°''a; City, Town or Village Thurman 5659 Co/
❑Burial Date Cemetery or Crematory
March 20,2018 Pine View Crematory
❑ ombment Address
®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
CO
O Date Point of
NTransportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
F, 1 Permit Issued to Registration Number
, Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
i:: 3809 Main Street,Warrensburg,NY 12885
P. s Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
a Address
,. Permission is hereby granted to dispose of the human remaii`describ ab s indicated.
Date Issued/9-4—
Registrar of Vital Statistics \ d,� i,r( /s�
(;I:na ure)
ti' District Number 5659 Place Thurman
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 3176 lig Place of Disposition ?q,5^, (, 1'—
W (address)
U)
re (section) (pot number) (grave number)
Q Name of Sexton or Person in Charg of Premises 6 ^r.k, S►.w+lt.
'Z 7 (pie se print)
Signature J Title l[tt mi
g 6i� hK.
(over)
DOH-1555 (02/2004)