O'Hara, Philip NEW YORK STATE DEPARTMENT OF HEALTH / , if Z 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Philip Joseph O'Hara Male
=' Date of Death Age If Veteran of U.S. Armed Forces,
January 2, 2016 56 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
fir: Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
Medical Certifier Name Title
Lynn M. Keil,
Address a
t Death Certificate Filed District Number Register Number
- City, Town or Village Glens Falls —Lvr /
"0❑Burial Date Cemetery or Crematory
January 11, 2016 Pine View Crematory
El Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
- Hold
g Date Point of
-- ❑Transportation Shipment
by Common Destination
n Carrier
❑ Disinterment Date Cemetery Address
❑ Renterment Date Cemetery Address
Permit Issued to Registration Number
4zz-
Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079
"' Address
3 82 Broadway, Fort Edward NY 12828
Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
Permission is he eby granted to dispose of the human 'ns escribed 4itoove as i dicat d.
Date Issued _ /, .�
Registrar of Vital Statis . s 1i�
��gnate)
District Number .`' 'C / Place -
l
I certify that the remains of the decedent identified above were disposed of in accordance with is permit on:
// Date of Disposition 01/11/2016 Place of Disposition Quaker Road Queensbury,NY 12804 124ut t.:
(address)
(section) /� (lot number) (grave number)
;- Name of Sexton or Person in Charge Premises 4 it rlbtA e• id OlKtt
(ple se print)
t Signature /72011634
(over)
DOH-1555 (02/2004)