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Coletti, Philip Paul NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Philip Paul Coletti Male Date of Death Age If Veteran of U.S.Armed Forces, 04/10/2021 65 Years War or Dates F Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital Q Manner of Death © Natural Cause 0 Accident 0 Homicide 0 Suicide �Undetermined �Pending ✓ Circumstances Investigation WG1 Medical Certifier Name Title William Cleaver MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 173 0 Burial Date Cemetery,Crematory or Facility Name 04/13/2021 Pine View Crematory El Entombment Address Cremation Queensbury Town,New York ❑Donation • Removal1-1 Date Place Removed and/or and/or Held - Hold Address N 0 f/) Transportation Date Point of p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom f Remains are Shipped,If Other than Above 2 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/12/2021 Registrar of Vital Statistics Robert Andrew Curtis(ECectronica1ySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition y��?ill Place of Disposition µ� dfi W 2 (address) W N C (section) (lot number) (grave number) Name of Sexton or Person in Charge of Premis s sf,M.1 Z (Met se print) �^ W Title Signature l Yt dt g DOH-1555(07/18)p t of 2 1v 4 ' ..1 Public Health Law Sec. 4145(2b) : Receipt Human remains of delivered on , 20 f Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#