Phillips, Alice NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
ALICE T. PHILLIPS Female
Date of Death Age If Veteran of U.S. Armed Forces,
April 17, 1999 86 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury, NY Street Address Hallmark Nursing Centre
Manner of Death Natural Cause ❑Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
S.R. Spitzer., MD.
Address
55 Sheridan St Glens Falls, NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Queensbury, NY 5657
Date Cemetery or Crematory
El Burial April 19, 1999 Pine View Crematory
Address
FX Cremation Quaker Road Queensbury, NY 12804
FDate Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & DennyFuneral Service 01565
Address
53 Quaker Rd Queensbury, NY 12804
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 re ins described above indicated.
Date Issued 4/19/99 Registrar of Vital Statistics
(s nature
District Number 5657 Place Town of Queensbury, NY .12804
I certify that the remains of the decedent identified above were disposed of n accordance with this permit on: `
WDate of Disposition Place of Disposition
a (address)
LLI
0 flC g (section) � n 2 ((lot n / (grave number)
Name of Sexton o Person in Charge of Premises �-1 /�'/
se print)
Signature Title
(over)
DOH-1555 (9/98)