Phillips, Carol NEW YORK STATE DEPARTMENT OF HEALTH f ' ' Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
CAROL PHILLIPS FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
12/06/2016 66 War or Dates
fr Place of Death Hospital, Institution
Zi City,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
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Manner of Death Natural Undetermined Pending
® ❑ Accident ❑ Homicide ❑ Suicide
❑
Cause Circumstances ❑ Investigation
eMedical Certifier Name Title
a CHRISTOPHER KEENAN DO
Address
- 43 NEW SCOTLAND AVE., ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 2555
Date Cemetery or Crematory
0 Burial 12/08/2016 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
Q' ❑ and/or Address
-; Hold
CO
0 Date Point of
0- Transportation Shipment
C,) ❑ By Common
CI Carrier Destination
ElDate Cemetery Address
Disinterment
❑ Date Cemetery Address
Renterment
Permit Issued To Registration Number
Name of Funeral Home COMPASSIONAT FUNERAL CARE INC 00364
Address
1402 MAPLE AVE SARATOGA SPRINGS NY 12866
Name of Funeral Firm Making Disposition or to Whom
"` Remains are Shipped, If Other than Above
tra Address
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..............
11. Permission is hereby granted to dispose of the human remains descri a above as in '}ated.
Date 12/07/2016 � {�I@�.9Veq QQ1Qkj$J
Registrar of Vital Statistics
Issued (si n ture)
District Number 101 Place City of Albany, NY ,,..
I certify that the remains of the decedent identified above were disposed of in accordance with' this permit on:
~' Date of Disposition It./'j It. Place of Disposition _ got l ,,t.-. tiftwkottlff4,,..
(address)
ui
rn
IX (section) (lot number) (grave number)
0 4
0
2 Name of Sexton or Person in Charge of Premises /11, � tvmat*
i
(please print)
Signature a Title 04',Pas
(over)
DOH-1555 (02/2004)