Whiting, Phyllis E �4
1 514
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
#: Name First Middle Last Sex
Phyllis Whiting Female
Date of Death Age If Veteran of U.S. Armed Forces,
August 5,2016 88 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death n Natural Cause Accident El Homicide Suicide ElUndetermined ❑Pending
Circumstances Investigation
Medical Certifier Name Title
Paul IL Filion Dr.
Address
3 Irongate Plaza,Glens Falls,NY 12801
Death Certificate Filed District Number FJ� \ Registecj`n b
City,Town or Village 1
❑Burial Date Cemetery or Crematory
Entombment August 9, 2016 Pine View Crematorium
Address
®Cremation 51 Quaker Road, Queensbury,NY 12804
Date Place Removed
Z El Removal and/or Held
g and/or Address
, Hold
0 Date Point of
n Transportation Shipment
p by Common Destination
Carrier
ID
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Road,Queensbury,NY 12804
f/ Name of Funeral Firm Making Disposition or to Whom
i, Remains are Shipped, If Other than Above
Address
•
Permission is hereby granted to dispose of the human remains describ d/�above�,s in t d.
Date Issued c73/O�(IC Registrar of Vital Statistics 4(e
(signature)
District Number 5�a/ Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
gW Date of Disposition t l)oi/(. Place of Disposition �, . --
(address)
CO
(section) (lot number) (grave number)
p
8 Name of Sexton or Person in Chary!of Premises Ar firL, s8
// (please print)
W Signature /d- Title L ht7i-
(over)
DOH-1555(02/2004)