Taylor, Laura - 4 9ft,
NEW YORK STATE DEPARTMENT OF HEALTifi I _ 11
Vital Records Section Burial - Transit Permit
iiiiiiiii Name First Middle Last Sex
Laura P. Taylor Female
iii Date of Death Age If Veteran of U.S. Armed Forces,
.Tan 1 d, 2018 96 yrs. War or Dates n/a
14 Place of Death Hospital, Institution or
City, Town or Village Fort Ann Street Address 1 423 Patten Mills Rd.
Manner of Death Natural Cause 0 Accident 0 Homicide ❑Suicide ❑Undetermined ri Pending
Circumstances Investigation
Lig Medical Certifier Name Title
0 David Foote, MD.
Address
€3 340A Main St. ,Hudson Falls, NY. 12839
iiig Death Certificate Filed District Number Register Number
City, Town or Village Fort Ann 5754 /.
Date Cemetery or Crematory
❑Burial Jan. 15, 2018 PineView Crematorium
Address
:.> ®Cremation Oueens urv, NY. 12804
Date Place Removed
2�Removal and/or Held
and/or Address
rAHold
6 Date Point of
fili❑Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
.;€€j Permit Issued to Registration Number
`' Name of Funeral Home Mason Funeral Home 01117
iN Address
18 George St_ Fort Ann, NY. 12827
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remaiks described above i 'cated.
Date Issued 1 /1 9/2 01 8 Registrar of Vital Statistics
signatu
>: District Number 5754 Place 4� �'L/ /Q,802 "7
iii
y
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
i ' (� p
W Date of Disposition 1/118 Place of Disposition f'�,IJ-.. ( :4_
+, (address)
w
CC (section) lot number)c (grave number)
0 Name of Sexton or Person in Charge of Pre . es 34-•"
2E 4 (please print)
Signature Title /10,11 -
(over)
DOH-1555 (9/98)