Irwin, Philip Brian " 73,E
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Philip Brian Irwin I Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/07/2019 58 Years War or Dates
II.- Place of Death Hospital,Institution or
WCity,Town or Village WarrensburgTown Street Address 31 Rays Road,Warrensburg Town, New York 12885
p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined ❑Pending
W Circumstances Investigation
V
W Medical Certifier Name Title
C Michael Bell MD
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Warrensburg 5660 18
Burial Date Cemetery,Crematory or Facility Name
11/08/2019 Pine View Crematory
Entombment Address
0 Cremation Queensbury Town,New York
❑Donation
OZ Removal Date Place Removed
and/or and/or Held
~ Hold Address
N
O
IL Date Point of
(A ❑Transportation Shipment
Q by Common
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
�.. Remains are Shipped,If Other than Above
Address
W
IL Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/08/2019 Registrar of Vital Statistics rponnaf7Com6s(E&tronicaf Sagneg)
(signature)
District Number 5660 Place Warrensburg, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
W
Date of Disposition ( ) Place of Disposition r t1 r�^-
Uj (address/
W
Q (section) (lot number/ (grave number)
atr
g Name of Sexton or Person in Charge of Premises 4ta ,-.
/p/e se print/
W Signature Zj/ Title �--
DO H-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 013062
Receipt
Human remains of delivered on � , 20
r
1
i
Pine View Cemetery Repr` ing the' ral home named on burial permit
Official Funeral Directors Reg.or License# ' �=