Phillips, Neil Gordon r ,
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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Neil Gordon Phillips Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/26/2020 41 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Glens Falls Street Address Glens Falls Hospital
`p Manner of Death El Natural Cause El Accident ❑Homicide ElSuicide ID Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
0 Scott Miller PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 489
❑Burial Date Cemetery,Crematory or Facility Name
10/28/2020 Pine View Crematory
EiEntombment Address
0 Cremation Queensbury Town,New York
❑Donation
Removal Date Place Removed
and/or and/or Held
F-N Hold Address
0
G. Date Point of
N ❑Transportation
p by Common Shipment
Carrier Destination
El Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/28/2020 Registrar of Vital Statistics Curtis(E/ctronical51Siwnea9
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
W Date of Disposition )Z1 ZU Place of Disposition g
2 ess)
W
Q (section) i1(lot number)\ (grave number)
SName of Sexton or Person in Cha of Premises ' e/jl1 f� L • yoA((r'
Z i /P/ seprintl ��,,��1l
W Signature � Title !►+�^ t
DOH-1555(07/18)p t of 2
11
Public Health Law Sec. 4145(2b) 3 4 1 5
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#