Taylor Jr., Raymond -# e 73
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Raymond Andrew Taylor,Jr. Male
Date of Death Age If Veteran of U.S. Armed Forces,
. September 03,2017 64 War or Dates
I— Place of Death Hospital, Institution or
W City, Town or Village Albany Street Address Albany Medical Center
p Manner of Death®Natural Cause ❑Accident ❑Homicide ❑Suicide El❑Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
Q Renee Dundon PA
Address
43 New Scotland Ave,Albany,NY 12208
Death Certificate Filed District Number Register mar
City, Town or Village Albany i,O 1 k Lt
❑Burial Date Cemetery or Crematory
September 07,2017 Pine View Crematorium
❑Entombment Address
" ®Cremation Quaker Road,Queensbury,NY
Date Place Removed
Z ❑Removal and/or Held
H and/or Address
CO Hold
O Date Point of
N ❑Transportation Shipment
a by Common Destination
4. Carrier
❑Disinterment Date Cemetery Address
0 Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home,Inc. 00281
,' Address
68 Main St.,Hudson Falls,NY 12839
Name of Funeral Firm Making Disposition or to Whom
I— Remains are Shipped, If Other than Above
a Address
Ce
0.' Permission is hereby granted to dispose of the human remai described a ve as indicated.
i n
Date Issued CA� ll'� Registrar of Vital Statistics env v"li 1Q,Q�'�i"L
(signature) I ,
District Number I p 1 Place C C , P-I
H I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition 'lit I1) Place of Disposition r►vlkJ Ans ri.--
W (address)
Cl)
Ce (section) lot number) (grave number)
pName of Sexton or Person in Charge of Premises — S/4.st
Z (ple(ph:Print) /tit
W Signature V' /fro- Title ! '' 101-Fi1.L
(over)
DOH-1555 (02/2004)