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Marcotte, Phillip Andre i NEW YORK STATE DEPARTMENT OF H EALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Phillip Andre Marcotte Male Date of Death Age If Veteran of U.S.Armed Forces, 02/01/2021 59 Years War or Dates 1982-1987 F Place of Death Hospital,Institution or Z City,Town or Village Saratoga Springs Street Address Saratoga Hospital W Undetermined Pending W Manner of Death © Natural Cause Accident Ei Homicide Suicide U Circumstances Investigation W Medical Certifier Name Title Catherine Dawson MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 115 ❑Burial Date Cemetery,Crematory or Facility Name 02/02/2021 Pine View Crematory ElEntombment Address ElCremation Queensbury Town,New York Donation IS Removal Date Place Removed and/or and/or Held ~ N Hold Address 0 1-1 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 Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/01/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F— Date of Disposition 21� 1 Z( Place of Disposition 21L ,JT� (address) W CC (section) (Io number) (grave number) 0 I G Name of Sexton or Person in Charge of Premises n�� �5r please pr ntJ Z W Signature Title AK44417,4 DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014495 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#