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Phelan, Sean Thomas NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sean Thomas Phelan Male Date of Death Age If Veteran of U.S.Armed Forces, 11/28/2023 67 Years War Of Dates f., Place of Death Hospital,Institution or W City,Town or Village Fort Edward Town Street Address 32 Gates Avenue, Fort Edward Town, New York 12828 p• Manner of Death Natural Cause Accident ❑Homicide Suicide Undetermined Pending U Circumstances Investigation LU 0 Medical Certifier Name Title Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 99 Burial Date Cemetery,Crematory or Facility Name 11/30/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ Removal Date Place Removed and/or and/or Held F.: N Hold Address O d Date Point of U)❑Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/30/2023 Registrar of Vital Statistics Aimee£Mahoney(E(ectronicalty Signed) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition /2'2'''[S Place of Disposition I i Aie Vie ) CPeotecir. ;- 2 (address) LU CC U) (section) (tot number (grave number) QO ` „� J Name of Sexton or Person in Cha of P mi s aMPni i /d (p ease print) W Signature .01r1V Title p6-Q.rAAPV- DOH-1555(07/18)p 1 of 2 8 Public Health Law Sec. 4145(2b) 7 7' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#