Taylor, Sarah Marie LF -2 CO
NEW YORKSTATE DEPARTMENT OF HEALTH '
Bureau of Vital Records Burial - Transit Permit
Name First Middle Last Sex
Sarah Marie Taylor Female
Date of Death Age If Veteran of U.S.Armed Forces,
08/29/2022 42 Years War or Dates
iL Place of Death Hospital,Institution or
WCity,Town or Village Minerva Town Street Address 608 MorseMemorial Highway,Minerva Town,New York 12857
a Manner of Death El Natural Cause Accident 0 Homicide ❑Suicide ElUndetermined 171Pending
VCircumstances Investigation
Medical Certifier Name Title
G Mike Valentine Coroner
Address
PO Box 132,Elizabethtown Town York 12932
Death Certificate Filed Torn Of Mi District Number Register Number
,Town orVill5e Ce 1557 2
Burial Date Cemetery,Crematory or Facility Name
09/01/2022 Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
nDonation
0❑'Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
Nnby Common
tion�a``----''by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Oueensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
H Remains are Shipped,If Other than Above
j Address
R
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 08/31/2022 Registrar of Vital Statistics 7>i'cizurffarlgYearo Sig
(signature)
District Number 1557 Place Town Of Minerva
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 9 Izi 2Z Place of Disposition .— .,s v._
au
2 (address)
W
NCle (section) 1 (/ot number) (grave number)
8 Name of Sexton or Person in Charge of mises r� ,c/.46.4.0
Z (plcse print)
111 (Signature "c:
Title
176m0�
DOH-t555(o7/18)p 1 of 2
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# '