McLaughlin, Philip 0 ♦i # -7 c
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Philip Warren McLaughlin Male
Date of Death Age If Veteran of U.S. Armed Forces,
0/27/2013 77 yrs. . War or Dates Korean War
a- P ce of Death Town of Hospital, Institution or
City, Town or Village Putnam Station Street Address 2218 Black Point Road
ILIa Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
uj Medical Certifier Na e Title
CIeed a ‘A emv �6
Address
Baal /1fA st-_ ,/,(2y,,, ?ALJ//On( ‘litS / . AV/a 8o/
Death Certificate Filed Town of District Number Register Number
City, Town or Village Putnam Station 5763
❑Burial Date Cemetery or Crematory
['Entombment12/02/2013 Pine View Crematory
Address
:. ;;❑X Cremation Queensbury, New York
Date Place Removed
Z ❑Removal and/or Held
t, and/or Address
H Hold
U)
O Date Point of
EL
❑Transportation Shipment
L3 by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Wilcox & Regan Funeral Home 01 821
Address .
11 Algonkin St:, Ticonderoga, New York 12883 •
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
• Address
I
ILI
97 Permission is he eb granted to dispose of the human rem - s described above as indicated.
Date Issued / 3 Registrar of Vital Statistics Q� ttizi42.4)01_,
(signature)
District Number ,5-763 Place Town of Putnam Station
'' I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
1-:
Z
ILLS Date of Disposition Iz-3-13 Place of Disposition t Imo. ..) CKwe(dro—
2 (address)
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Er (section) /j (lot umber) ( (grave number)
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• Name of Sexton or Person in Charge f Premises C/''�''J p+��
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MI
Signature Title C71. Mr-il10*-
(over)
DOH-1555 (02/2004)