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Taylor, Bertha Joan NEW YORKSTATE DEPARTMENT OF HEALTH - _ q Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Bertha Joan Taylor Female Date of Death Age !IfVeteran of U.S.Armed Forces, 04/15/2020 80 Years Waror Dates E,. Place of Death Hospital,Institution or WCity,Town or Village Newcomb Town Street Address 5675 State Route 28N Route,Newcomb Town,New York 12852 p Manner of Death © Natural Cause Accident Homicide ❑Suicide Undetermined Pending Qw Circumstances Investigation Medical Certifier Name Title Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed District Number Register Number City,Town or Village Newcomb 1559 2 ❑Burial Date Cemetery,Crematory or Facility Name 04/17/2020 Pine View Crematory MV Entombment Address IX 1 Cremation Queensbury Town,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held H N Hold Address O IL Date Point of N ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 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 F— Remains are Shipped,If Other than Above Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/16/2020 Registrar of Vital Statistics Mary Tound(ECectronicaCCySiyner) (signature) District Number 1559 Place Newcomb, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition '11� Zp Place of Disposition f, p uj (address) W cc N (section) (/ot number/ (grave number) 8 Name of Sexton or Person in Charg f Premises xol 4, Z as,.print/ W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 13 5 F' 9 Receipt i. Human remains of delivered on , 20— f Pine View Cemetery Representing the fdfieral home named on burial permit Official Funeral Directors Reg.or License#