Taylor, Jennie M Io(2-7
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Jennie M.Taylor Female
Date of Death Age If Veteran of U.S.Armed Forces,
12/11/2021 79 Years War or Dates
F Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Natural Cause ❑Accident El Homicide Suicide Undetermined Pending
Circumstances Investigation
0 Medical Certifier Name Title
Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 592
Burial Date Cemetery,Crematory or Facility Name
12/14/2021 Pine View Crematory
El Entombment Address
ElCremation Queensbury Town,New York
Donation
0 �Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
U) ❑Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander Baker Funeral Home 00037
Address
3809 Main St,Warrensburg,New York 12885
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12/13/2021 Registrar of Vital Statistics [R96ertAndrew Curtis(ECectronicaCCy Signed)
(signature)
District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z ;� f
W Date of Disposition 12 IN y Place of Disposition �'n cl'L ► df�y`
2 (address)
W
CC
(section) /1(lot number) (grave number)
SName of Sexton or Person in Charge of Premise 1 t ��'Q� ✓tnd►1lt
Z ��� (plea print)
W Signature �` Title a2CA1611
DOH-1555(07/18)p 1 of 2
. I,.. c,4 ors
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# a