Philiips, Melody 1 ret zIA-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Melody Edwardsen Phillips Female
Date of Death Age If Veteran of U.S. Armed Forces,
05/18/2011 57 years War or Dates
• Place of Death Hospital, Institution or
City, Toy xVi x C,IPns Falb Street Address 33 Gage Ave, Glens Falls, N Y
Manner of Death ill, IJlatural Cause ❑Accident ❑Homicide ElSuicide ❑Undetermined ❑Pending
W. Circumstances Investigation
la Medical Certifier Name Title
O. Timothy F Murphy Coroner
Address
52 Haviland Ave Glens Falls, N Y 12801
Death Certificate Filed District Number Register Number
City, TovVi}F enX Glens Falls 5601 233
`:❑Burial Date Cemetery or Crematory
❑Entombment 05/23/2011 Pine View Crematorium
Address
giii ❑Qremation Queensbury, NY 12804
Date Place Removed
N El❑Removal and/or Held
la and/or Address
"` Hold
0 Date Point of
cl`EI Transportation Shipment
G by Common Destination
ni Carrier
❑Disinterment Date Cemetery Address
•
iiiii
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Ni Name of Funeral Home Compassionate Funeral Care 01948
Address
402 Maple Street Saratoga Springs, NY 12866
illii Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
a Address
ttf
Permission is hereby granted to dispose of the human remains described above as indicated.
i Date Issued 05/20/2011 Registrar of Vital Statistics j� i..) t .1%-"'
(signah]ia)
District Number 5601 Place Glens Falls)Al v
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ill Date of Disposition 3-21-at Place of Disposition Pots VI.j Cf4„„,4 r,10,.-
(address)
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CC (section) (lot numbe)-- (grave number)
O ?on of Sexton or P on in Charge f Premises (',NA r N�(f
( lease print)
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• Si nature /� Title AZEMPttail.
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DOH-1555 (02/2004)