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Irsh, Lyn F. 2L,-2 NEW YORK STATE DEPARTMENT OF HEALTH Burial- Transit Permit Bureau of Vital Records Name First Middle Last Sex Lynn F.Irish Male Date of Death Age If Veteran of US.Armed Forces, 03/02/2021 87 Years War or Dates 1953-1955 F.. Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing ILI 0 Manner of Death ©Natural Cause ❑Accident ❑Homicide El Suicide El Undetermined Pending CU Circumstances Investigation W Medical Certifier Name Title C Roslyn Socolof MD Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 61 ElBurial Date Cemetery,Crematory or Facility Name 03/05/2021 Pineview Crematory 0 Entombment Address 0 Cremation Queensbury Town,New York ElDonation ElZ Removal Date Place Removed and/or and/or Held al Hold Address O O. Date Point of (I)❑Transportation p by Common Shipment Carrier Destination ElDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 3 Address W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/05/2021 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: ZW Date of Disposition 6--,712 Place of Dispositions ,J e C i-p�.t c 2 (address) W CC CC (section) (lot number) (grave number) SName of Sexton or Person in Charge o Premises R/Ifrioa (please print) W Signature i l/ Title pry' DOH-15551o7h8)p t of 2 Public Health Law Sec. 4145(2b) 01 4 614 a' Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#