Tyrrell, Rodney yz1
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rodney G Tyrrell Male
Date of Death Age If Veteran of U.S. Armed Forces,
05/27/2018 79 Years War or Dates
}- Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death J Natural Cause Accident ❑Homicide Suicide Undetermined Pending
ui Circumstances Investigation
W Medical Certifier Name Title
O Joanne Cooper PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 259
❑Burial Date Cemetery or Crematory
05/29/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
Z❑Removal and/or Held
and/or Address
Hold
ri Date Point of
co Li Transportation Shipment
G by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Edward L Kelly Funeral Home 00519
Address
PO Box 548,Schroon Lake,New York 12870
Name of Funeral Firm Making Disposition or to Whom
t Remains are Shipped, If Other than Above
2 Address
OC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/29/2018 Registrar of Vital Statistics Rg6ertA Curtis(ECectronicallySigned)
(signature)
District Number 5601 Place Glens Falls, New York
certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
• Date of Disposition WI f ig Place of Disposition f��,(�,,,
(address)
N
re (section) i (lot number) (grave number)
pName of Sexton or Person in Charge of Premises / An,{ 3- i'�
(lease print)
W Signature Title ( 14lg_
(over)
DOH-1555 (02/2004)