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Philion Jr., Donald Joseph NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald Joseph Philion Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 10/28/2021 51 Years War or Dates 1990-1993 Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 8 C Carmella Drive,Moreau Town,New York 12831 ▪ Manner of Death Undetermined Pending O ©Natural Cause �Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title O Douglas Cline MD Address 43 South Western Avenue,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 53 ▪Burial Date Cemetery,Crematory or Facility Name 11/02/2021 Pine View Crematorium Entombment Address X❑Cremation Queensbury Town,New York ElDonation Removal Date Place Removed and/or and/or Held N Hold Address 0 0. Date Point of Cl) ❑Transportation 5by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/02/2021 Registrar of Vital Statistics Geeann Mc cabe(Electronically Signed) (signature) District Number 4562 Place Moreau, 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 'j/ III Place of Disposition ` b "`i[4-_.- r.>46:1—___ tu 2 (address) W CO CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises I 11 to �''� 'hti�+ Z (p se print) W Ci?/+Fn►t g Si nature '/2 Title LP '` DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of , delivered on , 20 Pine View Cemetery Representing the funeral home named on.l?urial.permit Official Funeral Directors Reg.or License#