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Phillips, Elsie NEW YORK STATE DEPARTMENT OF HEALTH - ' ' dn Vital Records Section Burial - Transit Permit , Name First Middle Last Sex 03 Elsie L. Phillips Female Date of Death Age If Veteran of U.S. Armed Forces, December 6, 2016 92 War or Dates at a Place of Death Hospital, Institution or City, Town or Village Granville Street Address The Orchard Nursing Home Manner of Death J Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined n Pending Circumstances Investigation Medical Certifier N me Title es ill D -` -` Address / C)ii 2 l a.. e_ou-l-e_, (-I 0 G'r I k V ! 2 3 Z ,i, Death Certificate Filed 1 District Nunlber ( Register Number 41 City, Town or Village Granville S 15(Q 49 fit❑Burial Date Cemetery or Crematory 1 December 9, 2016 Pine View Crematory ❑Entombment Address k©Cremation Quaker Road Queensbury,NY 12804 41 Date Place Removed *ri Removal and/or Held 5 I and/or Address F.e Hold Date Point of Itic ❑Transportation Shipment by Common Destination Carrier 4, Date Cemetery Address Li Disinterment ❑ Renterment Date Cemetery Address Ilf Permit Issued to Registration Number Name of Funeral Home M. B. Kilmer Funeral Home- FE 01079 s11:0, Address 0� 82 Broadway, Fort Edward NY 12828 Name of Funeral Firm Making Disposition or to Whom ft Remains are Shipped, If Other than Above Address 0,# 4 Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued I a J D g Jap I 6 Registrar of Vital Statistics I�% iet 'Ilcutteelb (signature) District Number -�_�� 5-7S(D Place ?Dwn) o r G RANvI`L-t pez certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 12/99i2016 Place of Disposition Quaker Road Queensbury,NY 12804 %heO e1u)G%sr lalll (address) (section) k (lot tuber) (grave number) g Name of Sexto r er in Charge of Premises t t )140 &,rY14-r,4.e ir (please print) Signature Title L/L'Prre,id i (over) DOH-1555 (02/2004)