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Lyon, Joseph Hamilton
NEW YORK STATE DEPARTMENT OF HEALTHf i Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Hamilton Lyon Male Date of Death Age If Veteran of U.S.Armed Forces, 05/13/2021 80 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Bolton Town Street Address 47 Rainbow Drive,Bolton Town, New York 12824 pManner of Death ©Natural Cause 1=1 Accident ❑Homicide 0 Suicide ❑Undetermined ❑Pending W Circumstances Investigation W Medical Certifier Name Title 0 Bryan Smead MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Village Bolton Landing 5650 8 ❑Burial Date Cemetery,Crematory or Facility Name 05/18/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York 0 Donation OZ ❑Removal Date Place Removed and/or and/or Held ~ Hold Address N 0 Date Point of Cl) Li Transportation Shipment p by Common Carrier Destination El Disinterment Date Cemetery Address El 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 I— Remains are Shipped,If Other than Above 2 Address CC W D. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/17/2021 Registrar of Vital Statistics Jodi Petteys(E(ectronica((y Signed) (signature) District Number 5650 Place Bolton Landing, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /, Z ......1L Or1- W Date of Disposition 5�I$� l� Place of Disposition (address) W N (section) (lot nu r/ (grave number) Q Name of Sexton or Person in Charge of Pre ises /�!'S "'"w11 Z S / se print) W i nature "..../) ,�� Title C'" � Signature DOH-355(07/18)p 1 of 2 R R Public Health Law Sec. 4145(2b) 014795 Receipt • Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# /