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Turner, Jaylyn Faith # 1110 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jaylyn Faith Turner Female Date of Death Age If Veteran of U.S.Armed Forces, 11/02/2020 5 Mins. War or Dates Place of Death Hospital,Institution or Ill• City,Town or Village Glens Falls Street Address Glens Falls Hospital G Manner of Death ❑X Natural Cause El Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending VCircumstances Investigation W Medical Certifier Name Title G Kerry Wickert MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 503 ❑Burial Date Cemetery,Crematory or Facility Name 11/09/2020 Pine View Crematory ❑Entombment Address gCremation Queensbury,New York ❑Donation ©0 Removal Date Place Removed and/or and/or Held F— Hold Address CO 0 O. Date Point of (0 1-1 Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address ❑Reinterment Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom f Remains are Shipped,If Other than Above a Address IC W CL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/09/2020 Registrar of Vital Statistics RP6ertA?urlrewCurtr(Ekrtronicaf S tte' (signature) District Number 5601 Place Glens Falls, New York I certifythat the remains of the decedent identified above were disposed of in accordance with this ermi on: IH ,J P p WDate of Disposition 11110)Zfl Place of Disposition w'1- 2 (address) W Cl) (section) A(lot number) (grave number) SName of Sexton or Person in Charge of r ises r i � k LJu' (P/ a print) W ..�p,�,Signature Title t(a� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0 1 4 1 8 2 1 Receipt Human remains of delivered on , 20 3 I Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# I ;