Armitage, Phyllis NEW YORK STATE DEPARTMENT OF HEALTH s 444 10 1 Z-
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Phyllis Eileen Armitage F
Date of Death Age If Veteran of U.S. Armed Forces,
08/20/2015 57 War or Dates
}- Place of Death Hospital, Institution or Community Hospice Inn
City, tXor) Albany Street Address at St. Peter's Hospital
ILAa Manner of Death X❑ Natural Cause ❑Accident ❑Homicide ❑Suicide El Undetermined ❑Pending
Circumstances Investigation
iii Medical Certifier Name Title
P. Rebecca Keim MD
Address
319 South Manning Blvd. Albany, NY 12208
Death Certificate Filed District Number Register Number .
City, TCOVIOX or 1 Albany 101
['Burial Date Cemetery or Crematory
• 08/24/2015 Pine View Crematorium
•
i<❑Entombment Address
ii®Cremation . 53 Quaker Road, Queensbury, New York 12804
Date Place Removed
Removal and/or Held
U. and/or
,,;;L—I Address
I
• Hold
0 Date Point of
0 Li Transportation Shipment
G by Common Destination
Xi Carrier _
Disinterment Date Cemetery Address
Mi LiReinterment Date Cemetery Address
a Li Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
68 Main St. P.O. Box 67 Hudson Falls, New York 12839
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
I •
W.
Permission is hereby granted to dispose of the human m in escribed above as indicated.
Date Issued U• 22,i Registrar of Vital Statistics (44 1 4-2pi#/ )44
/ (signature)
<i District Number Mi., Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition flzc(ic Place of Disposition ,ea. ( or,...
2 (address)
Ill
0
CC (section) Opt number) (grave number)
Name of Sexton or Person in Charge of Premises it,bk. 30441
de- ( lease print)
SignatureTitle AVAM
(over)
DOH-1555 (02/2004)