Lyons, Phillip , rill- *) -14 34
NEWYORKSTATEDEPARTMENTOFHEALTH \---',/ Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Phillip Lyons Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/05/2023 52 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Kingsbury Town Street Address 110 Deer Run Drive, Kingsbury Town,New York 12839
in Manner of Death Natural Cause Accident Homicide. Suicide Undetermined Pending
W Circumstances II Investigation
W Medical Certifier Name Title
CI John Aiken Coroner
Address
40 Burquist Road,Fort Ann Town,New York 12827
Death Certificate Filed Town Of Kingsbury District Number Register Number
City,Town or Village 5762 2
—Burial Date Cemetery,Crematory or Facility Name
01/10/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
Z Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
(I)❑Transportation Shipment
p by Common
Carrier Destination
El
Disinterment
Date Cemetery Address
Date Cemetery Address
❑Reinterment
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
1._ Remains are Shipped,If Other than Above
Address
'C
W
0-
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/09/2023 Registrar of Vital Statistics Cynthia Bardfin(E(ectronical(y Signed)
(signature)
District Number 5762 Place Town Of Kingsbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition 1/)d113 Place of Disposition ��.,,.LL l_
2 (address)
W
Cl)CC (section) (lot number) l —7:4, (grave number)
0 Name of Sexton or Person in Charge of emises `-
(plea Se print)
W Signature Title
DOH-1555(07/18)p 1 of 2
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#