McPhillips, Neil Gerald yr
G
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Neil Gerald McPhillips Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/24/2021 68 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 ❑Accident ❑Homicide Suicide Undetermined Pending
(W) Circumstances Investigation
CI Medical Certifier Name Title
Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 308
❑Burial Date Cemetery,Crematory or Facility Name
07/26/2021 Pine View Crematory
❑Entombment Address
gCremation Queensbury,New York
Donation
Z Date Place Removed
0 Removal and/or Held
— and/or
N Hold Address
0
CI. Date Point of
Cl) Transportation
6by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596
Address
407 Bay Rd,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
j- Remains are Shipped,If Other than Above
• Address
Q
lt1
CI. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/26/2021 Registrar of Vital Statistics 'o6ert,'nrlrew Curtis.(E/ctronicaa Signed)
(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 ' -?$'.-d Place of Disposition pi 4,V'eit j („0 t0
(address)
W
Q (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises a e / Gy S' ;(-C,S
Z (please print)
W Signature 4./ap, Title Vet")^:4cir
DOH-1555(o7/18)p t of 2
Public Health Law Sec. 4145(2b) `. 7 3
Receipt
Human remains of delivered on , 20
t_ .
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#