Taylor, Hermas J NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
Name First Middle Last Sex
Hermas Joseph Taylor Male
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Date of Death Age If Veteran of U.S.Armed Forces,
March 5 , 1988 84 War or Dates NO
:Z: Place of Death Hospital, Institution or
City,Town or Village Village Cambridge : Street Address Mary McClellan Hospital
Cause of Death
rul
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Medical Certifier Name Title
William E. Carroll , MD, 88 Main St . , Greenwich, N.Y.
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Death Certificate Filed District Number Register Number
City,Town or Village V i 11 age Cambr i dge
Date Cemetery or Crematory
❑Burial
March 7 , 1988 Pine View Cemetery & Crematorium
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Cremation
Address
Town of Queensbury, New York
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Z' Date Place Removed
O; ❑ Removal and/or Held
and/or Hold :::::::::::::::::::::::......:::::::.....:::::::::::::::::::::::::::::::::::::::::::;:.:::::::::::::......:::::::::::::::::::::::::,:::::::::::::::::::::::::::::::::::::::::::::::::::::::::::,::::::::::::............:::::::::::::::::
Address
0. Date Point of
to ❑Transportation by.. Shipment
Common Carrier .....................................................................................................................................................................................................
CS: :............... ................ ...................................... ........ . .
Destination
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❑ Disinterment Date : Cemetery Address
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❑ Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Firm Carleton Funeral Home, Inc. 00356
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Address Main St . , Hudson Falls , N.Y. 12839
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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 dead human remains described above as indicated.
Date Issuedlt� Registrar of Vital Statistics
(signature)
District Number ����/ Places
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition Place of Disposition '�N,�"'//
2 (address)
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c (section) (lot number) ave number)
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p Name of Secton or Person ' Charge of Premises ,6PVA Lz T�// T���
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uI Signature �J Title �i/) ���! /�/( � l�sJ/
DOH -1555 (9/86)p 1 of 2(formerly VS-61)