Taylor, Robert . - t # 631
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
" Name First Middle Last Sex
t Robert Taylor Male
Date of Death Age If Veteran of U.S. Armed Forces,
:.. August 29, 2015 39 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Argyle Street Address 2312 Coach Road
Manner of Death❑ Natural Cause ❑ Accident El Homicide I Homicide Suicide ❑ Undetermined X❑ Pending
Circumstances Investigation
Medical Certifier Name Title
`' Max Crossman, M.D. Dr.
Address
eit 65 Poultney Steet Whitehall, NY 12887
Death Certificate Filed District Number Register Number
% -" City, Town or Village Argyle c)7S b Liy
} ❑Burial Date Cemetery or Crematory
September 1, 2015 Pine View Crematory
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
2t Date Place Removed
❑ Removal and/or Held
. , and/or Address
Hold
Date I Point of
` ti ❑Transportation Shipment
s by Common Destination
Carrier
t ❑ Disinterment
Date Cemetery Address
❑ Reinterment
Date Cemetery Address
„
Permit Issued to Registration Number
viaName of Funeral Home M. B. Kilmer Funeral Home-Argyle 01077
Address
123 Main St., Argyle NY 12809
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 described above as indicated.
Date Issued 911 1 ,a p 15 Registrar of Vital Statistics oy►'`t?llli, ,_
(signature)
s District Number S So Place /L{
ram. I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition 09/01/2015 Place of Disposition Quaker Road Queensbury,NY 12804
(address)
(section) (lot number) (grave number)
,; Name of Sexton or Person in Charge of Premises grtlikt- S �
(please print)
Signature Title 0, lt.
(over)
DOH-1555 (02/2004)