Taylor, Dorothy NEW YORK STATE DEPARTMENT OF HEALTH r , ' "` �
Vital Records Section Burial - Transit Permit
Name First Middl ast ,ex
Dorothy Marie Taylor
Date of Death 0 6/2 5/2 01 8 Age 8 8 If Veteran of U.S. Armed Forces,
War or Dates
Place of Death Hospital, Institution or
City, Town or Village Ballston Street Address 6 Forestbrook Dr.
Manner of Death E Undetermined ❑ Pendin
Natural Cause AccidentHomicide Suicide g
Circumstances Investigation
Medical Certifier Name at t Title
Address /y�� r
gi 3 e 50 R,6.. 50 71
Death Certificate Filed District umb r Re ster N ber
City, Town or Village �� i
0 Burial Date 0 6/2 7/2 018 Cemetery or CrematoryPi ne View Crematory
❑Entombment Address
�. ..Cremation 21 Quaker Road, Queensbury, NY
Date Place Removed
r—i Removal
and/or and/or Held
Hold Address
Date Point of
Transportation Shipment
by Common Destination
Carrier
v!ax Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to M.13. Kilmer Funeral Home Registration Number
Name of Funeral Home01 078
Address
136 Main Street, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is her by gr nted to dispose of the humane ains describ b v indi ted.
Date Issued 6 alp Registrar of Vital Statistics C.-Ci ` avid
(signature)
District Number L.}-bSO Place 1- 3� It ( �� //
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 4 I isilig Place of Disposition ?- lr ,,..
(address)
(section) (lot num// er) (grave number)
Name of Sexton or Person in Charge of Premises (� So s«.
' (please pri )
Signature n ✓T Title (t ihritu1
(over)
DOH-1555 (02/2004)