Taylor, John NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit rermit
Name First Middle Last Sex
John G. Taylor Male
Date of Death Age If Veteran of U.S. Armed Forces,
` December 29,2013 88 War or Dates World War H
Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause 1 l Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Ali Medical Certifier Name Title
�a Dr.John Sawyer,MD
Address
, 14 Manor Drive,Queensbury,NY 12804
Death Certificate Filed District Number Register Number
:;, City, Town or Village Glens Falls 5601 S /
❑Burial Date Cemetery or Crematory
Entombment December 31,2013 Pine View Crematory
Address
0 Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
z 3809 Main Street,Warrensburg,NY 12885
,,Y Name of Funeral Firm Making Disposition or to Whom
t ►1 Remains are Shipped, If Other than Above
Address
I
14,
Permission is hereby granted to dispose of the human remains descri ed a ove in
Date Issued %23I ZD/3 Registrar of Vital Statistics .' � x
signature)
1
•.'-'1 District Number 5601 Place Glens Falls �,0//a�G/
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 0/31113 Place of Disposition -Rti -+ &-sfcrI-
W (address)
C (section) (lot numb (grave number)
QName of Sexton or Person in Charg of Premises /1;,4�,L,- r nrVf
'Z (please print)
Signature Title CV M Tpj
(over)
DOH-1555 (02/2004)