Naylor, Edith NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section N Burial - Transit Permit
Name First Middle Last Sex
Edith Augusta Naylor Female
,µ
Date of Death Age If Veteran of U.S. Armed Forces,
09/22/2017 85 Years War or Dates
1 Place of Death Hospital, Institution or
City, Town or Village Granville Village Street Address Indian River Rehabilitation And Nursing Center
W Manner of Death i Natural Cause ❑Accident 0 Homicide ❑Suicide ❑Undetermined Pending
Circumstances Investigation
U.
Medical Certifier Name Title
Thomas Kandora MD
Address
17 Madison St,Granville Village,New York 12832
Death Certificate Filed District Number Register Number
City, Town or Village Granville Village 5725 27
❑Burial Date Cemetery or Crematory
09/22/2017 Pine View Crematory
❑Entombment Address
®Cremation Queensbury, New York
Date Place Removed
Z❑Removal and/or Held
1 and/or Address
Hold
C3 Date Point of
Q Transportation Shipment
by Common Destination
Carrier
Q 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
k- Remains are Shipped, If Other than Above
2 Address
Permission is hereby g dispose to dis ose of the human remains described above as indicated.
Date Issued 09/22/2017 Registrar of Vital Statistics tcharewp6erts ElectronicaaySigned"
(signature)
District Number 5725 Place Granville Village, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition q'ii,117 Place of Disposition ?AL 4.n42foct4-..,
(address)
11,1
te (section) p(lot number) (grave number)
Name of Sexton or Person in Charge of Premises 6 4 -)cvis't
(please print)
111 Signature "C �1 Title owing.
(over)
DOH-1555 (02/2004)