Taylor, James NEW YORK STATE DEPARTMENT OF HEALTH ' 14 it
Vital Records Section Burial - Transit Permit
/
Name First James Middle M Last Taylor Sex Male
Date c859* 14 Age 48years If Veteran of U.S. Armed Forces,
War or Dates no
• Place of '�� � Hospital, Institution or
W City, TowEr bYYilla Schenectady Street Address Ellis Hospital
a Manner of Death 0 Nfatural Cause EI.Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
iP Michael Sikirica M.D.
Addre Broad Street, Waterford, New York 12188
Death Ce e,� Schenectady District Number
ber Register Number
460City, Townilra449
❑Burial Date 05/16/2014 Cemetery or Crematory
Pineview Crematorium
['Entombment Address
1.❑d'emation Queensbury, N Y
Date Place Removed
Z ❑Removal and/or Held
2 and/or Address
H Hold
till
O Date Point of
es ❑Transportation Shipment
L3 by Common Destination
Carrier
El Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address 402 Maple Avenue, Saratoga Springs, Ny 12866
Name of Funeral Firm Making Disposition or to Whom
14. Remains are Shipped, If Other than Above
2 Address
t
lI
:0" Permission is hereby granted to dispose of the human remains de tbe b v as reed.
05/13/2014 ,�� tta,
eLl
ia Date Issued Registrar of Vital Statistics
ignature)
District Number 4601 Place Schenectady
:;; I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
IF- �i
V0 Lit Date of Disposition 6/jp i� Place of Disposition c,v.�,1
2 (address)
W:
67
CC (section) (lot number (grave number)
▪ Name of Sexton or Person . Charge o Premises ' ��'"�
Z (plgase print)
41 Signature
Title cecrvYetro kt
(over)
• DOH-1555 (02/2004)