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Taylor, Mabel NEW YORK STATE DEPARTMENT OF HEALTH �1 Vital Records Section Burial - Transit Permit Name First Middle Last Sex Mabel Mae Taylor Female Date of Death Age If Veteran of U.S. Armed Forces, April 27, 2011 90 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital Manner of DeathrnNatural Cause n Accident 0 Homicide Suicide Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Joseph Foote MD, Address Rt 4 Hudson Falls, NY 12839 Death Certificate Filed District Rert,f,Vieber City, Town or Village �D ❑Burial Date Cemetery or Crematory May 3, 2011 Pine View Crematorium ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed El Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home, Inc. 00276 Address Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839 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 remains desc ib d o as Date Issued Oj/02./Z V Registrar of Vital Statistics �lez (/l r (signature) District Number \Q/ Place ,��y� Aj�� Ai I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 5-4-0 Place of Disposition ,ylhty Cr(Mc fcrrig"- (address) (section) dr.sy (lot numb (grave number) Name of Sexton or Per n in Char e f Premises ►- J..,i,J4}- 9please print) Signature Title �2t; Mf (over) DOH-1555 (02/2004)