Irish, Karl 2
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Karl E. Irish Male
Date of Death Age If Veteran of U.S. Armed Forces,
September 6,2013 89 War or Dates
}},,..� Place of Death Hospital, Institutior) iirondack Tri-County Health Care
Z" City, Town or Village Johnsburg Street Address Center
aManner
of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending
Circumstances Investigation
us: Medical Certifier Name Title
Thomas Warrington
Address
HHHN,Johnsburg,NY 12843
Death Certificate Filed District Number Registel,Number
City, Town or Village Johnsburg 5655 L 7
❑Burial Date Cemetery or Crematory
September 9,2013 Pine View Crematory
❑Entombment Address
®Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z I I Removal and/or Held
O and/or Address
H Hold
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aDate Point of
co Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
r Permit Issued to Registration Number
-:° Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
=3a Permission is hereby granted to dispose of the human r ins described ab ve as ' i ated.
Date Issued q-- q�02rDI Registrar of Vital Statistics /Q
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District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
wDate of Disposition 1110E13 Place of Disposition grtVituo (rIoNe for,,,,._
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pCL (section) � � (lot pumber) (grave number)
Name of Sexton or Person in Charge of P emises (,�, S�a.{�-
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Signature4 Title C1 €Mt 10 .
(over)
DOH-1555 (02/2004)