Phillips, Lawrence I it b (o
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section n . d Burial - Transit Permit
' Name First Middle Last Sex
Lawrence T.K Phillips Male
Date of Death Age If Veteran of U.S. Armed Forces,
Sep 4, 2016 83 WarorDates 1952-60
Place of Death Hospital, Institution or
AltizA Town xiikVi1 xx Argyle Street Address , . sigingt on Center
ot Manner of Death❑Natural Cause ❑ Accident ❑ Homicide ❑ Suicide L. Undetermined ❑ Pending
Lul Circumstances Investigation
W Medical Certifier Name Title
Edit Masaba, MD MD
Address
Argyle, NY
Death Certificate Filed District Number Register Number
Vic, Town or Viitagexxx Argyle 57YU .y7
= 0 Burial Date Cemetery or Crematory
- _r qep 7, 2016 Pine View Crematorium
";!?7,.;Li❑Entombment Address
Cremation Queensbury, NY
Date Place Removed
❑ Removal and/or Held
and/or Address
t-r Hold
Date Point of
❑Transportation Shipment
(0 by Common Destination
i;, Carrier
4 ❑ Disinterment Date Cemetery Address
C. ❑ Reinterment
Date Cemetery Address
T : Permit Issued to Registration Number
''' Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main St. , Hudson Falls, NY
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
drie
Permission is hereby granted to dispose of the human re sins described above as indicated.
Date Issued 9 i (, 1 1 o16 Registrar of Vital Statistics k LQ,t ,),,
(signature)
District Number S 1 S 0 Place C y k{ 1 1..1\I
4,13
t-,4 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i'MDate of Disposition q g Place of Disposition Uttu.)
lit P � �16 p got nc 1/ r'"^atrcwrn
;' (address)
a
i (section) dot,
ot number) Jc. (grave number)
1:13 Name of Sexton or Person in Charge of Premises I+�'/ O (P print) p
,a Signature o��Jv`Vv�, Title Cmi��i
(over)
DOH-1555 (02/2004)