Taylor Sr, Edwin PI
NEW YORK STATE DEPARTMENT OF HEALTH 1 33S
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
EDWIN NORMAN TAYLOR SR. MALE
Date of Death Age If Veteran of U.S.Armed Forces,
05/21/2014 75 War or Dates 1956-1960
I— Place of Death Hospital, Institution
W City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Manner of Death Natural Undetermined Pending
® El Natural ❑ Homicide El Suicide ❑ ❑
W Cause Circumstances Investigation
W' Medical Certifier Name Title
p AVI ALIN MD
Address
43 NEW SCOTLAND AVE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 974
Date Cemetery or Crematory
El Burial 05/27/2014 PINE VIEW CREMATORY
❑ Entombment Address
® Cremation QUEENSBURY, NY .
Date I Place Removed
Z Removal and/or Held
O El and/or Address
- Hold
Q Date Point of
a Transportation Shipment
Cl) El By Common
fli Carrier Destination
❑ Date Cemetery Address
Disinterment
ElDate Cemetery Address
Reinterment
Permit Issued To Registration Number
Name of Funeral Home MB KILMER FUNERAL HOME 01079
1' Address
82 BROADWAY FORT EDWARD, NY 12828
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped, If Other than Above
MAddress
Ui
n- Permission is hereby granted to dispose of the human remains descriloes.1 above as indi ed. /
Date 05/21/2014 ;,3� : f / /
Issued Registrar of Vital Statistics (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance w ith this permit on:
li Date of Disposition 5/i i IV Place of Disposition ,.aVN —•r" r'—
L (address)
W''
co
iX (section) (lo unber) (grave number)
O
Z Name of Sexton or Person in Charge of Premises nf , SO1'
(please print)
Signature I.. 4....... Title C.itftl}(�Q
0-
(over)
DOH-1555 (02/2004)