Taylor, Elizabeth A `TC
NEW YORK STATE DEPARTMENT OF HEAKHBurial - Transit Permit
Vital Records Section -,_,i
Name First Middle Last Sex
Elizabeth A. Taylor Female
Date of Death Age If Veteran of U.S.Armed Forces,
1. February 14, 2006 64 War or Dates
2 Place of Death Hospital, Institution or
W City,Town,or Village Argyle Street Address Pleasant Valley Health Center
G Manner of Death X❑ Natural Cause ❑ Accident ❑ Homicide ❑Suicide ❑Undetermined ❑ Pending
W Circumstances Investigation
G Medical Certifier Name Title
W Dr. Edit Masaba MD Dr.
Q Address
1 Myrtle Ave. , Cambridge, NY 12816
Death Certificate Filed District Number ,. Register Number
City,Town or Village Argyle J-7 � 12—
❑Burial Date Cemetery or Crematory
February 16, 2006 Pine View Crematory
❑Entombment Address
❑R Cremation Quaker Road Queensbury, NY 12804
Date Place Removed
0 ❑ Removal and/or Held
- and/or Address
Hold
0 Date Point of
0 ❑Transportation Shipment
a by Common Destination
Carrier
Date Cemetery Address
h ❑ Disinterment
�I ❑Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M. B. Kilmer Funeral Home 01140
Address
123 Main St. , Argyle, New York 12809
~ Name of Funeral Firm Making Disposition or to Whom
x• Remains are Shipped, If Other than Above
W Address
a.
Permission is hi reby granted to dispose of the human re 's described ab ye indicated.
Date Issued S31 (a Registrar of Vital Statistics 4111 A'aii f0'
(signature)
District Number 57 Sn Place Argyle,New York
F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 02/16/2006 Place of Disposition Pine View Crematory
2 (address)
W
0 (section) (lot number) (grave number)
W Name of Sexton or Person in Charge of Premises L9.14 i2,c�/ 6yf �4-
2 1. (please print)
W Signature 9 5 Title
(over)
DOH-1555 (02/2004)