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Philion, Florence A. 411) NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records _`.,. Name First Middle Last Sex s + Female fie,? Florence k Philion �r , Date of Death Age If Veteran of U.S.Armed Forces, ,V1 02/20/2021 92 Years War or Dates t Place of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing Ob Manner of Death ©Natural Cause Accident ❑Homicide 0 Suicide ❑Undetermined El Pending Circumstances Investigation Medical Certifier Name Title Wendy Steinhacker PA Address ,.;,' 42 Gurney Ln,Queensbury Town,New York 12804 4 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 55 ©Burial Date Cemetery,Crematory or Facility Name 02/27/2021 Pine View Cemetery L,. ❑Entombment Address v,w❑Cremation Queensbury Town,New York ❑Donation El Removal Date Place Removed 11. and/or and/or Held r. Hold Address , Li Transportation Date Point of Shipment g by Common ': Carrier Destination .l Date Cemetery Address ❑Disinterment ❑Reinterment Date Cemetery Address IV Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address ''`a 407 Bay Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address t Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/23/2021 Registrar of Vital Statistics Caroline 2fi(degarie Barber(E(ectronica1Ty Signed) -', (signature) District Number 5657 Place Queensbury, New York 7 I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 2/2 7/2 0 21 Place of Disposition 21 Qu ak' r Rd_ Queen Gb ry NY 2 0 4 /address/ Uncas 508/29 5 (section/ (lot number) Connie Goedert (grave number) Name of Sexton or erson in Charge of Premises (please print) Signature kith �D.- ^— 4�-lc Title Superintendent DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 012845 Receipt . . Human remains of :.-_ , \ . , r delivered on . - , / , 20 .' / , . . / /,' i ."") , /i .."( -.' , - _ \ _-.1 j.„ __i_j__.-4 - ,----- 1 Fine View Cemetery Representing the funeral ome named on burial permit 1 /Official Funeral Directors Reg.or License# 3 7 r, 61 PHILION NAME Florence A. Philion Age: 92 Lot Owner: George J. Adams Lot# Uncas 508 Sec. 29 Grave# 5 Case: Concrete Died:2/2 0.2 0 21 Interred:2/2 7/2 0 21 Funeral Home: Singleton Sullivan Potter FH Cemetery: Pine View