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Taylor, Nancy M ri. IT VI NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Nancy M Taylor Female Date of Death Age If Veteran of U.S.Armed Forces, 10/25/2021 68 Years War or Dates F_ Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital Wp Manner of Death ©Natural Cause El Accident Homicide 0 Suicide El Undetermined 0 Pending O Circumstances Investigation 0 Medical Certifier Name Title Numan Rashid MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 618 ElBurial Date Cemetery,Crematory or Facility Name 10/27/2021 Pineview Crematory Entombment Address Cremation Queensbury Town,New York ElDonation ZEl Removal Date Place Removed H and/or and/or Held N Hold Address 0 0. Date Point of U) L j Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Densmore Funeral Home Inc 00448 Address 7 Sherman Ave,Corinth,New York 12822 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address Q W O Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/27/2021 Registrar of Vital Statistics John Paul Franck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z W Date of Disposition �c tail( Place of Disposition4,�L,, (..it-er4....._ 2 (address) W Cl) Q (section) i(!ot number/ (grave number) Z Name of Sexton or Person in Charge o Premises �`1ss a tf� D /pleas�eirint/ W Signature /( Title �l'til"4-pc DOH-1555(07/18)p 1 of 2 I Public Health Law Sec. 4145(2b) � 6 0 Receipt Human remains of delivered on , 20. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#