Naylor, Daniel Thomas Jr. -'y # q 1`6
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NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
T
Name First Middle Last. Sex
Daniel Thomas Naylor Jr. Male
Date of Death Age If Veteran of U.S.Armed Forces, ,
10/17/2022 44 Years War or Dates
H Place of Death Hospital,Institution or
tZ City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death LI Natural Cause ❑Accident 0Homicide D,S.uicide DUndetermined Pending
✓ .x; Circumstances Investigation
W Medical Certifier Name Title
G Timothy Murphy _ Coroner
Address
52 Haviland Avenue,Glens Falls,New York 12801 -
Death Certificate Filed City Of Glens Falls ! District Number Register Number
City,town or Village ' # 530
Burial Date Cemetery,Crematory or Facility Name
10/181
2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
DDonation
Z nRemoval 'Date Place Removed
(�^�arrd/or and/or Held
a to Hold Address
0
Date Point of
N❑Transportation Shipment
Q by Common
Carrier Destination
Date Cemetery Address
'Disinterment
Date Cemetery Address
El Reinterment
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
H- Remains are Shipped,If Other than Above
5 Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/18/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify thatthe remains of the decedent identified above were disposed of in accordance with this permit on: �
Date of Disposition /0119 I Z Z Place of Disposition -RA t.V,..., l .—
UJ
g (address/
W
N (section/ /1 (lot number) /grave number/
0� c/
• Name of Sexton or Person in Charge of P piles r �".
Z (plea print/ /
W Signature .�- Title ` et�'►�TnF
DOH 1555(o1118)p i 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#