Michaud, Tylor Ryan (ILI). .ic (j)A
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Tylor Ryan Michaud Male
Date of Death Age If Veteran of U.S.Armed Forces,
08/03/2022 31 Years War or Dates
C~ Place of Death Hospital,Institution or
Z City,Town or Village Malta Town Street Address 21 Dugan Hill Road, Malta Town, New York 12118
w Manner of Death n n nUndetermined Pending�
W I I Natural Cause Accident I I Homicide nSuicide I I I^ I
U Circumstances Investigation
W Medical Certifier Name Title
Ca Anthony Perniciaro Coroner
Address
6012 County Farm Road,Ballston Spa Village, New York 12020
Death Certificate Filed Town Of Malta District Number Register Number
City,Town or Village 4560 45
Burial Date Cemetery,Crematory or Facility Name
08/06/2022 Pine View Crematorium
nEntombment Address
Cremation Queensbury Town, New York
CDonation
0nRemovat Date Place Removed
and/or and/or Held
f- Hold Address
0
d Date Point of •
N Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
nDisinterment
n Date Cemetery Address
I Reinterment
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67, Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
f— Remains are Shipped,If Other than Above
2 Address
IX
W
Ct" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/05/2022 Registrar of Vital Statistics JennaiferAtarie Holmes(Efectronicafly Signed)
(signature)
District Number 4560 Place Town Of Malta
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H
wDate of Disposition Place of Disposition �@ v:e� r�
2 cress)
W
co
cc (section) /lot ember/ (gave number)
dName of Sexton or Person in Charge f Premis ,J�h7Ur.)t.
Z (please print)
tJ1 Signature � Title Ceer s—
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#