Hammond, Phillip NEW YORK STATE DEPARTMENT OF HEALTH 'f x s # 251.
Vital Records Section Burial - Transit Permit
it
q np" Name First Middle Last Sex
' ` Phillip J. Hammond Male
1$'. Date of Death Age If Veteran of U.S. Armed Forces,
# a April 15,2015 74 War or Dates
Place of Death Hospital, institution or
City, Town or Village Chester Street Address 617 Bird Pond Road
rra Manner of Death Undetermined Pending
Natural Cause _ Accident I I Homicide Suicide
W. Circumstances Investigation
Fes_° Medical Certifier Name Title
e Daniel Way MD
ii Address
HUHN,North Creek,NY 12853
% Death Certificate Filed District Number Register Number
_` City, Town or Village T/O Chester,NY �(o,5A 5652- ,J
❑Burial Date Cemetery or Crematory
April 20,2015 Pine View Crematory
❑Entombment Address
OX Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
LD and/or Address
Hold
U).
0 Date Point of
c 1 'Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
r1 Name of Funeral Home Alexander-Baker Funeral Home 00037
; a Address
F , 3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
tlrJ� /�
Permission is hereby ranted to dispose of the human rema' s escrided a v s indic ed.
¢ Date Issued 04-17-15 Registrar of Vital Statistics ,?,/i. ,
%_ (sign ture)
District Number n t0 a Place T/O Chester,NY
=k
I certify that the remains of the decedent identified above were disposed ofa.,
in accordance with this permit on:
W Date of Disposition q!24fi( Place of Disposition cdtot4,.._
2 (address)
W
N
x (section) J (lot nymber) (grave number)
pName of Sexton or Person in Charge of Premises �
Z (please print)
w Signature it ..e..... Title C(6`" 4
(over)
DOH-1555(02/2004)