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Taylor, Gardner L f-/o0 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gardner L Taylor Male Date of Death Age If Veteran of U.S.Armed Forces, 02/02/2022 79 Years War or Dates 1960-62 Place of Death Hospital,Institution or WCity,Town or Village Corinth Town Street Address 665 Main St,Corinth Town,New York 12822 p Manner of Death ©Natural Cause EiAccident ❑Homicide Suicide El Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title 0 Ishtpreet Uppal MD Address 113 Holland Avenue,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Corinth 4553 1 ❑Burial Date Cemetery,Crematory or Facility Name 02/03/2022 Pineview Crematory ElEntombment Address Cremation Queensbury Town,New York El Donation Removal Date Place Removed and/or and/or Held ~ Hold Address 0 O. Date Point of ID ❑Transportation Shipment Q by Common 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 H Remains are Shipped,If Other than Above a Address Er W • Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/03/2022 Registrar of Vital Statistics Brenda L Penis(Electronically Signed) (signature) District Number 4553 Place Corinth, 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 i'—.3--A-),%-y U Place of Disposition �;f Q_J C C,6'e.&o le CY 2 (address) W cc (section) (lot number) (grave number) el Name of Sexton or Per in Charge of Premises J eft./ ey (please print) W Signature �� C��Title wuc=4c DOH-1555(07/18)p 1 of 2 015602 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 e .r Pine View Cemetery Representing the funeral home named op burial permit Official Funeral Directors Reg.or License# t