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Phillips, Robert NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit _ Name First Middle Last Sex Robert Frederick Phillips Male Date of Death Age If Veteran of U.S. Armed Forces, 07/18/2017 89 Years War or Dates 1953-1957 Place of Death Hospital, Institution or 5"P''' City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Suzanne Rayeski DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number F City, Town or Village Glens Falls 5601 397 -, ❑Burial Date Cemetery or Crematory 07/20/2017 I Pine View Crematory ❑Entombment Address st-'®Cremation Quensbury, New York Date Place Removed ❑Removal and/or Held Land/or Address Hold .0. Date Point of reil❑Transportation Shipment FrIli by Common Destination Carrier ❑Disinterment Date Cemetery Address , Date Cemetery Address ❑Reinterment Permit Issued to Registration Number 4 Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077 Address 123 Main St,Argyle,New York 12809 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address E 4,: Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/20/2017 Registrar of Vital Statistics WpbertA Clow ElectronicaaySigned ,..., ..„. (signature) in District Number 5601 Place Glens Falls, New York rl I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: VIA a Date of Disposition 7/2//7 Place of Disposition p i he V J G,/'-pn t 4. (address) 4.1 ' , (section) (lot num er) (grave number) ril Name of Sexton o in arge of Premises ,-J +-.-I r , ~.6.2e (please print) riri Signature "—� Title G''e-a-fr `ate,i (over) DOH-1555(02/2004)