Winslow, Philip NEW YORK STATE DEPARTMENT OF HEALTH ct
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Philip James Winslow Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 30, 2014 75 War or Dates
Place of Death Hospital, Institution or
W City, Town or Village Hudson Falls Street Address 3 Quarry Crossing Street
W Manner of Death 0 Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
Circumstances Investigation
WW Medical Certifier Name Title
Anthony Petracca MD,
Address
Three Irongate Center Glens Falls, NY 12801
Death Certificate FiiledG DisttJ i Registe,�Number
Cit (Towner Village b (9 1 L G—j
❑Burial Date Cemetery or Crematory
September 2, 2014 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
z ❑ Removal and/or Held
• and/or Address
H Hold St. Paul's Cemetery
Date Point of
• ❑Transportation Shipment
CO by Common Destination
Li Carrier
❑ Disinterment Date Cemetery Address
❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
2` Address
CL W
Permission is hereby granted to dispose of the human re ins descr' ed a v as indicated.
Date Issued l�(3-0I� Registrar of Vital Statistics C \ �(
(signature)
District NumbercC9V---) Place )
I certify that the remains of the decedent identified above were disposed of in ad. ordance wi this permit on:
W Date of Disposition 09/02/2014 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
W
co
re (section) �/ (lot number) (grave number)
• Name of Sexton or Person in Charge of Premises St
Z (plase print)
W Signature Title amt,Aprit
(over)
DOH-1555 (02/2004)