McPhee, Shirley r : / 3 Cl/
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial _ Transit Permit
Name First Middle Last Sex
Shirley Elizabeth McPhee Female
Date of Death Age r If Veteran of U.S.Armed Forces,
i. February 11, 2017 G 1u War or Dates
WPlace of Death Hospital,Institution or --_.- �'}
City,Town,or Village Queensbury Street Address Residence -12 �'4 1 1G}Li ✓/2/GEC--
G Manner of Death n Natural Cause n Accident I I Homicide OSuicide D Undetermined n Pending
W Circumstances Investigation
U Medical Certifier Name Title
al Dr. Anthony Petracca, M.D. Dr.
0 Address
3 Irongate Center, Glens Falls, NY 12801
Death Certificate Filed DiWetNum_ber R ister Number
City,Town or Village Queensbury (9-C,
❑Burial Date Cemetery or Crematory
February 17, 2017 Pineview Crematorium
❑Entombment Address
• Cremation 21 Quaker Road Queensbury, NY 12804
Date Place Removed
0 n Removal and/or Held
▪ and/or Address
I" Hold
1) Date Point of
0 ❑Transportation Shipment
ti by Common Destination
Carrier
Date Cemetery Address
on Disinterment
U Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Jillson Funeral Home, Inc. 00885
Address
46 Williams Street, Whitehall, New York 12887
t= Name of Funeral Firm Making Disposition or to Whom
et• Remains are Shipped,If Other than Above
W Address
a
Permission is hereby ranted to dispose of the human remai s described above as indicated.
Date Issued L'�-i t Registrar of Vital Statistics (- ---- q (7)A f2-C__),,.,
(signature)
District Number. Place Queensbury,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 02/17/2017 Place of Disposition Pineview Crematorium
2 (address)
W
0
0 (section) (lot n ber) (grave number)
00 Name of Sexton or P n' Charge of Premises ,� L•.)i c ✓i 6. 4..vnet r='I-€
2 (pleaseprint)tu , i
/
Signature , Title G/G�'�'/G 4, T�
(over)
DOH-1555 (02J2 04)