Kent, Philip Sarvent Jr. . 4r-- g o-)
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-
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Philip Sarvent Kent Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/29/2022 63 Years War or Dates
F.. Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 54 Orville Street,Glens Falls,New York 12801
O Manner of Death III Natural Cause Accident El Homicide Suicide Undetermined ❑Pending
ILI
C.) Circumstances Investigation
W Medical Certifier Name Title
O Charles Yun MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 397
HBurial Date Cemetery,Crematory or Facility Name
08/01/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
❑and/or
Removal Date Place Removed
and/or Held
H
tR Hold Address
0
O. Date Point of
CO❑Transportation
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
0 Rei nterme nt
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
5 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/01/2022 Registrar of Vital Statistics Megan.Nolin(ECectronicallySigned)
(signature)
District Number 5601 Place
City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4.---
ai~
Date of Disposition aIi Place of Disposition '3,4L
2 (address)
W
NCC (section) (lot number) s I (grave number)
O Name of Sexton or Person in Charg Premises na
*1---'se print)
Z l i!
W Signature _ Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
1
1
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#