Long, Philip Bruce # $zZ
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Philip Bruce Long Male
Date of Death Age If Veteran of U.S.Armed Forces, .
09/26/2021 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
11.1
p Manner of Death X❑Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Marcille Labban MD
*Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed. * District Number Register Number
,City,Town or Villag , k. Glens Falls 5601 417
❑Burial Date Cemetery,Crematory or Facility Name
09/28/2021 Pine View Crematory
❑Entombment Address
❑Cremation QueenstsuryTowrr,-New York
ElDonation
O El Removal Date Place Removed
and/or and/or Held
Hold Address
0
a. Date Point of
U) Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
El Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/27/2021 Registrar of Vital Statistics e2odertf?nrlrew Curtis.gectronicallj,Sign4
(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:
C~ p
Z Date of Disposition I I Za IZi Place of Disposition �.,,��� (Ad111
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2 (a dress)
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CC CC (section) (tot number) (grave number)
O Name of Sexton or Person in Charge of Pre isesnS L- '���
(plea print)
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Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of : ' ' ' 'I '' 4 delivered on I ' ' ',-. , 20
f '
Pine View Cemetery Representing the funeralthome named,on burial peimit
Official Funeral Directors Reg.or License#