Philo, Harry ARTMENT OF HEALTH E a ��
NEW YORK STATE DEP Vital Records Section Burial - Transit Permit
,
i
Name First Middle Last Sex
Harry M. Philo Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 28,2012 87 War or Dates WWII
.: Place of Death Hospital, Institution or
City, Town or Village Queensbury Street Address 10 Cedar Ct.
es Manner of Death n Natural Cause 'Accident n Homicide n Suicide 'Undetermined Pending
. Circumstances Investigation
Medical Certifier Name Title
'a` Address
Death Certificate Filed Queensbury District Number Igi ter Number
City, Town or Village 5657
❑Burial Date Cemetery or Crematory
May 30,2012 Pine View Crematorium
❑Entombment Address
ID Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ I I Removal and/or Held
and/or Address
F' Hold
CO
0 Date Point of
N U Transportation Shipment
a by Common Destination
Carrier
U Disinterment Date Cemetery Address
Li Renterment Date Cemetery Address
'nf Permit Issued to Registration Number
=3_Name of Funeral Home Singleton Sullivan Potter Funeral Home I 01596
Address
407 Bay Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
ii;',4 Remains are Shipped, If Other than Above
Address
Ii
Gt Permission is hereby granted to dispose of the huma remains described above as indicated.
Date Issued���C�� Registrar of Vital Statistics �r-�- CA . ��3L.�rl,t—x.--
(signature)
District Number 5657 Place Queensbury
I certify that the remains of the decedent identified above were disposedof in accordance with this permit on:
LU gip-604eLl Date of Disposition 07 Lit (14- Place of Disposition �rtrr4ocivi
(address)
W
CC (section) ii,(lot number) (grave number)
p Name of Sexton or Person in Charge of remises hi,
St}(JT Sth�H
Z I (please print)
W SignatureAL Title Ck#YrFft O/L
(over)
DOH-1555(02/2004)