Phillips, Paula 7 /`/O
NEW YORK STATE DEPARTMENT OF HEALTH leg,Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Paula Phillips Female
Date of Death Age If Veteran of U.S. Armed Forces,
• _: March 12, 2014 93 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Moreau Street Address Home of The Good Shepherd
Manner of Death El Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri❑ Pending
Circumstances Investigation
Medical Certifier Name Title
_ John Sawyer, M.D. Dr.
Address
asi
161 Carey Road Queensbury, NY 12804
Death Certificate Filed District Number Register Number
-, City, Town or Village Moreau
0 Burial Date Cemetery or Crematory
March 13, 2014 Pine View Crematory
25,❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
❑ Removal and/or Held
and/or Address
Hold
Date Point of
_ ❑Transportation Shipment
by Common Destination
Carrier
• ❑ Disinterment Date Cemetery Address
, IllRenterment 3,7
Date Cemetery Address
'' =: Permit Issued to Registration Number
Name of Funeral Home M.B. Kilmer Funeral Home 01078
Address
136 Main Street, South Glens Falls NY 12803
• Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human rem ins described above as indicated.
Date Issued 3//3/ig/ Registrar of Vital Statistics ,4. .,.. 9 nn
(signature)
District Number �6 6 a Place / , V
.- I certify that the remains of the decedent identified above were disposed of in accordance with this ermit on:
Date of Disposition 03/13/2014 Place of Disposition Quaker Road Queensbury,NY 12804 i`4/4t7(6-1,
(address)
(section) Q umb r) J (grave number)
/ S0a1 i-� ►c1
Name of Sexton or •rson • arge of Premises
lease pri t)
Signature Title CY(4'11/4/4 *1
✓/- (over)
DOH-1555 (02/2004)