Irwin, Michael Earl • CCF) Z'31e
NEW YORK STATE DEPARTMENT OF HEALTH ' Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michael Earl Irwin Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/23/2023 74 Years War or Dates 1969-1975
Place of Death Hospital,Institution or
Z City,Town or Village Hartford Town Street Address 59 Russell Lane,Hartford Town,New York 12809
WW Manner of Death Unetermneendin
Natural Cause Accident Homicide Suicide nd id Pending
V Circumstances Investigation
W Medical Certifier Name Title
Joseph Mihindukulasuriya MD
Address
20 Murray Street,Glens Falls,New York 12801
Death Certificate Filed Town Of Hartford District Number Register Number
City,Town or Village 5759 4
Burial Date Cemetery,Crematory or Facility Name
wow 03/25/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
N Hold Address -
0
a Date Point of
Li)ElTransportation
p by Common Shipment
Carrier Destination
nDisinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Argyle 01077
Address
123 Main St,Argyle,New York 12809
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
CC
W -
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/25/2023 Registrar of Vital Statistics Denzre(Petteys(ElctromCaf1y Signed)
(signature)
District Number 5759 Place Town Of Hartford
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 3IZgI7,3 Place of Disposition
2 (address)
W
CC N
(sec'n) (lot number) (grave number)
0 Name of Sexton or Person in Charge of Pre i s Ili !�
Z lease print)
W Signature Title 0/11
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#