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Kaylie, Doris N EW YORK STATE DEPARTMENT OF HEALTH Burial - Transit PeT11'llt Bureau of Vital Records Name First Middle Last Sex Doris Ka lie Female Date of Death Age If Veteran of US.Armed Forces, 05/08/2020 784 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Oyster Bay Town Street Address Plainview Hospital Manner of Death © Natural Cause Accident Homicide M Suicide Undetermined Pending Medical Certifier Name Title Circumstances Investigation Tommy Chau MD Address 888 Old Country Rd,Oyster Bay Town,New York 11803 Death Certificate Filed District Number Register Number City,Town or Village Oyster Bay 2952 ❑Burial Date Cemetery,Crematory or Facility Name 05/14/2020 Pine View Cemetery and Crematorium Entombment Address Cremation Queensbury Hamlet,New York ❑Donation ❑Removal Date Place Removed and/or and/or Held Hold Address ❑Transportation Date Point of by Common Shipment _ Carrier Destination Disinterment Date Cemetery Address �a El Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home N F Walker Inc 01234 Address 2039 Merrick Avenue,Merrick Hamlet,New York 11566 Name of Funeral Firm Making Disposition orto Whom Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/10/2020 Registrar of Vital Statistics P*hardLouisLa9karca(ECectronicaCCySiyned) (signature) District Number 2952 Place Oyster Bay, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 5' l5'1 Zp Place of Disposition EL ZM (address) (sedion) (lot number) (grave number) Name of Sexton or Person in Charge of Pr wises P.j R L— jr (pleas print) Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 013 -� Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named ou,burial.permit Official Funeral Directors Reg.or License# /'