Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Rateau, Phyllis B.
4 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Phyllis B.Rateau Female Date of Death Age If Veteran of U.S.Armed Forces, 01/01/2021 89 Years War or Dates 1_ Place of Death Hospital,Institution or W City,Town or Village Granville Village Street Address Granville Center for Rehabilitation and Nursing `IJ p Manner of Death ©Natural Cause ❑Accident 1=1 Homicide ❑Suicide El Undetermined El Pending Circumstances Investigation LU Medical Certifier Name Title CI Leonard Gelman MD Address 17 Madison St,Granville Village,New York 12832 Death Certificate Filed District Number Register Number City,Town or Village Granville Village 5725 01 Burial Date Cemetery,Crematory or Facility Name 01/04/2021 Pineview Crematorium Entombment Address Cremation Queensbury Town,New York }„t" ❑Donation 0 Removal Date Place Removed and/or and/or Held o Hold Address 0 CL Date Point of U) 11 Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above 2 Address CC W d Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/04/2021 Registrar of Vital Statistics Richard Roberts(Electronically Signed) (signature) District Number 5725 Place Granville Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZW Date of Disposition Place of Disposition 2 (address) W NCC (section) (lot number) (grave number) gName of Sexton or Person in Charge of Pr, mises f r`t �^ Z (ptlse print) /' 7 LUSignature (s✓� Title 4 I�+� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) '114369 Receipt Human remains of r' J, , '!- delivered on °/., /7/- , 20 Pine View Cemetery Representing the funeral home named on byrial permi Official Funeral Directors Reg.or License#, �`' /