Hilton, Philip 111 10
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Philip Edward Hilton Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 3, 2017 63 War or Dates
e of Death Hospital, Institution or
LltCi , Town or Village Glens Falls Street Address 26 Pine Street
la nner of Death Friu Natural Cause ❑ Accident El Homicide E Suicide El Undetermined El Pending
Circumstances Investigation
Medical Certifier Name Title
lid` James J. Murray,
Address
377 Church Street Saratoga Springs, NY 12866
V y,4: D - 'Certificate Filed District Number / Register Number
own or Village �t,e v wl-\S C ,LN 5601 I 1
■ :urial Date Cemetery or Crematory
January 5, 2017 Pine View Crematorium
0 Entombment
Address
'E :IZI Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
zriRemoval and/or Held
and/or Address
E Hold
0 Date Point of
' El Transportation Shipment
by Common Destination
0 Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
34 0Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom t
Remains are Shipped, If Other than Above
Address
bv
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issuedi / 1;'1 2egistrar of Vital Statistics LA�. L2°
(signature)`
District Number 5601 Place s ��.,.5 \.\s c.f U
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 01/05/2017 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
tkil
(section) / (lot number) , (grave number)
. Name of Sexton or Person in Charge of Premises ^r<< _'►�tl
Zi / lease print)
Signature k 'e, - Title iiP0111A-rdt
(over)
DOH-1555 (02/2004) 1 ,