Wescott, Phyllis i 41
NEW YORK STATE DEPARTMENT OF HEALTH ' V' i V
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Phyllis J Wescott Female
> Date of Death Age If Veteran of U.S. Armed Forces,
February 28, 2016 _ 71 _ War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Granville Street Address The Orchard Nursing Centre, Inc.
QManner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
G
Address
Death Certificate Filed District Number ;75L0 Register Number
City, Town or Village Granville
❑Burial Date Cemetery or Crematory
March 4, 2016 Pine View Crematory
❑Entombment Address
❑X Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
ne' Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2 Address
4'. Permission is hereby granted to dispose of the human remains describedabove as indicated.
Date Issued c� (: of(..p Registrar of Vital Statistics ti• q 1�'
I / `\ C.
�''� • (signature)
`. li
District Number 5 5 Lo Place Granville TCLUI'A
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 3)11A, Place of Disposition -F (L' 6 e¢Orh•-.._
W (address)
N
CL (section) (lot num er) (grave number)
pName of Sexton or Person in Charge of Premises Akill,- L�
Z please print)
W
Signature ! Title iriAttrOfi
I (over)
DOH-1555(02/2004)