Girard, Philip NEW YORK STATE DEPARTMENT OF HEALTH x '#`
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex .
Philip Nelson Girard M
Date of Death Age If Veteran of U.S. Armed Forces,
05/27/2014 75 War or Dates Vietnam
#.• Place of Death Hospital, Institution or
ZCity, Town or Village Queensbury Street Address 165 Robert Gardens North Apt_ 1
Manner of Death 0 Natural Cause El Accident 0 Homicide 0 Suicide 0 Undetermined Pending
la Circumstances Investigation
Medical Certifier Name Title
'p Ageel A. Gillani MD
Address
102 Park St. Pruyn Pavilion Glens Falls,NY 12801
Death Certificate Filed Dis ict Number Re aster Number
City,-Town or Village Queensbury `(.9
['Burial Date Cemetery or Crematory
06/02/2014 Pineview Crematory
`i QEntombment-Address
®Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
❑and/or Address
F Hold
IA
O Date Point of
tJ0��
Transportation Shipment
0 by Common Destination
Carrier
El Disinterment Date " Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home MB Kilmer Funeral Home 01 078
<: Address
136 Main St. , South Glens Falls,NY 12803
Name of.Funeral Firm Making Disposition or to Whom
14. Remains are Shipped, If Other than Above
" Address
CC
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Permission is hereby granted to dispose of the human mains described above as indicated.
Date Issued Sij / Registrar of Vital Statistics GZ � P�
I (signature)
District Number S6 c' Place ) C h--r� O O.
z
I certify that the remains of the decedent identified above were disposed of in a orda ce with this permit on:
Ill Date of Disposition b 4Jry Place of Disposition ZzVA) LtwsveAlt --
2 (address)
ILL
it (section) I
(lot numbers (grave(grave number)
ti Name of Sexton or Person Charge f Premises j;/ � J(''t��+
(plepse print)
w
Signature ,"°" Title G
(over)
DOH-1555 (02/2004)