Tyrrell, Philip R I(9c7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Philip R Tyrrell Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2022 79 Years War or Dates 1961-1965
H Place of Death Hospital,Institution or
W City,Town or Village Schroon Town Street Address 226 River Road,Schroon Town,New York 12870
• Manner of Death 0 Natural Cause Accident 0 Homicide 0 Suicide 11 Undetermined Pending
C3 Circumstances Investigation
WW Medical Certifier Name Title
0 Tanya Finch NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Schroon Lake 1563 1
EjBurial Date Cemetery,Crematory or Facility Name
02/07/2022 Pine View Crematory
Entombment Address
aCremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
V) ❑Transportation
p by Common Shipment
Carrier Destination
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
Remains are Shipped,If Other than Above
2 Address
W
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/04/2022 Registrar of Vital Statistics Patrick;SavanegYectronicallySrgnea9
(signature)
District Number 1563 Place Schroon Lake, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
L—
Z Date of Disposition Place of Disposition
W
2 (address)
W
to
CC (sedan) llot number) (grave number)
0 Name of Sexton or Person in Charge of Premises
Z (please print)
W Signature Title
DOH-1555(07/18)p 1 of 2
•
015610
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#