Phillips, Margaret Irene Ij 2S8
NEW YORK STATE DEPARTMENT OF HEALTH
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Margaret Irene Phillips Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/07/2021 66 Years War or Dates
E,. Place of Death • Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 6 Briggs Court,Queensbury Town,New York 12804
LU
'p Manner of Death El Natural Cause El Accident Homicide ElSuicide Undetermined Pending
Circumstances Investigation
WMedical Certifier Name Title
0 Darci Gaiotti-Grubbs MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 65
0 Burial Date Cemetery,Crematory or Facility Name
03/10/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
0 Removal Date Place Removed
and/or and/or Held
H Hold Address
0
A. Date Point of
NL j Transportation
Q by Common Shipment
Carrier Destination
0 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
F— Remains are Shipped,If Other than Above
5 Address
cc
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/10/2021 Registrar of Vital Statistics Carnrnex/garde Bar6er((Yectronicall'Signed)
(signature)
District Number 5657 Place Queensbury, 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 31111 2i Place of Disposition
2 (address)
LU
(section) (lot number) (grave number)
S Name of Sexton or Person in Charge of Premises _ a L
(pleA print)
W 00(
Signature � Title ��
DOH-1555(07/1.8)p t of 2
10
Public Health Law Sec. 4145(2b) 1 ``
Receipt
•
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#