Taylor, Mary 5-17
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Mary Alice Taylor Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/23/2018 93 Years War or Dates
Place of Death Hospital, Institution or
City, Town or Village Queensbury Town Street Address The Stanton Nursing And Rehabilitation Centre
Manner of Death®Natural Cause ❑Accident Homicide �Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Roslyn Socolof MD
Address
, ; 152 Sherman Ave,Queensbury Town,New York 12801
Death Certificate Filed District Number Register Number
• City, Town or Village Queensbury 5657 85
• ❑BUrlal
Date Cemetery or Crematory
06/26/2018 Pine View Crematory
❑Entombment Address
®Cremation Queensbury Town, New York
Date Place Removed
❑Removal and/or Held
and/or Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
El Disinterment Date Cemetery Address
Q Reinterment
Date Cemetery Address
• Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
j NY
A-sl
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/26/2018 Registrar of Vital Statistics Caroline J(cBarber(Elect ronwally Signed)
(signature)
s District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition hi (lg Place of Disposition
(address)
(section) number) (grave number)
Name of Sexton or Person in Charge of Premises iL �1'•'r*
(pi se print)
Signature Title h MnrN-
(over)
DOH-1555(02/2004)