Philo, Jean ft
NEW YORK STATE DEPARTMENT OF HEALTH ���
Vital Records Section Burial - Transit Permit
Name First Middle ' Last Sex
Jean L. Philo Female
Date of Death Age If Veteran of U.S. Armed Forces,
May 27, 2011 r 86 ! War or Dafes
ZPlace of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 10 Cedar Court
p Manner of Death I XI Natural Cause Accident n Homicide Suicide Undetermined Pending
US Circumstances Investigation
Medical Certifier Name Title
. Richard Leach,MD
Address
Glens Falls,NY
Death Certificate Filed I District Number Register Number
• City, Town or Village Queensbury,NY I 5657 y '
❑Burial Date Cemetery or Crematory
May 31,2011 Pine View Crematory
❑Entombment Address
0 Cremation Quaker Road, Queensbury,NY 12801
1 Date Place Removed
Z
—Removal 1 and/or Held
and/or Address
H Hold
N
O Date I Point of
Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
r--Reinterment Date Cemetery Address
I
Permit Issued to Registration Number
Name of Funeral Home Singleton-Healy Funeral Home 1 01622
• Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
;M Remains are Shipped, If Other than Above
X Address
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Permission is hereby granted to dispose of the human r mains described
�abo as indicated.
Date Issued 5-- A -.�v i I Registrar of Vital Statistics - - ' �.
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(signature)
District Number 5657 Place Queensbury,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
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UJ Date of Disposition te- I-It Place of Disposition t",,,AVx0tn<tof U '.+
Ili (address)
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O (section) `t-(lot numb�' (grave number)
pName of Sexton or Person in Charge of Premises al c isk Jr _)0wit
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Signature li (f)/ ).___
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Title Cee.
(over)
DOH-1555(02/2004)