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Smith, Phillip Loyd NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Philip Loyd Smith Male Date of Death Age If Veteran of U.S.Armed Forces, 06/27/2023 83 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death 0 Natural Cause Accident Homicide Suicide Undetermined riPending W Circumstances Investigation W Medical Certifier Name Title 0 Kasandra Frasier PA 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 318 L Burial Date Cemetery,Crematory or Facility Name 06/30/2023 Pine View Cemetery Entombment Address Cremation Queensbury Town,New York Donation Removal Date Place Removed and/or and/or Held F- Hold Address 0 d Date Point of (I)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/28/2023 Registrar of Vital Statistics Megan No(mn(Electronically Signed) (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: Z1 Date of Disposition l p•�j6•p�3 Place of Disposition oi��L��eR R,Q Ql�l�X'►S � qJ\\ ps (address) N s � # a 57/5� (s (lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises ©Clt1 Z c (please print) W Signature ,Mt tf1. , it Title ��7E'�R DOH-1555(07/18)p t of 2 Public Health Law Sec. 4145(2b) 012988 Receipt Human remains of delivered on , 20_ Pi iew Cemetery Representing the funeral home named on burial_permit Ofticial Funeral Directors Reg.or License# ' SMITH 1 Lr Lot No. 53-54 Address PO Box 82 , Glens Falls NY 12801 Section No. 2 Owner Mr & Mrs Phillip Smith Plot S . I . Date 10/6/83 Approx. 200 Superficial ft. Location Bounded on North by Vacayts South by S . I . #1 , East by Vacant , West by Vacant . Corner Posts Remarks Deed No. (and changes) 1804 Payment Record Paid in Full 10/6/83 • Record of Interments L . DI . t P11i�i a� V � 2 V ,f Wilma Jean Smith 12/9/03 TZ U 4 , C S u A/ S A/ X A 4; 1 2. 3 (t J: .r * f Form No. 01 SMITH :F NAME PhillipLoyd Smith Age` 83 Lot Owner: Mr. & Mrs. Phillip Smith Lot# S&I #2 Grave# 1 Case: Concrete Died: 6.2 7.2 3 Interred: 6.3 0.2 3 Funeral Home: Baker FH Cemetery: Pine View