Taylor, John William NEW YORKSTATE DEPARTMENT OF HEALTH a t"i •
Burial - Transit Permit
Bureau of Vital Records F—
Name First Middle Last Sex
John William Taylor Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/16/2023 56 Years War or Dates
t- Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address 30 Morgan Avenue Apt#C,Glens Falls, New York 12801
p Manner of Death ❑Natural Cause Accident Homicide Suicide ❑Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
a Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 38
Burial Date Cemetery,Crematory or Facility Name
R01/23/2023 Pine View Crematory
Entombment Address
IICremation Queensbury Town,New York
Donation
8❑Removal Date Place Removed
and/or and/or Held
H Hold Address
CO
0
O. Date Point of
(q❑Transportation Shipment
a by Common
Carrier Destination
oDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
2 Address
IX
LI
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/19/2023 Registrar of Vital Statistics Megan Min(Efectronica1TySigned)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /�
----� !�_
W Date of Disposition I �Z S\13 Place of Disposition -1I-IL
2 (address)
W
cc (section) 1/ (lot (grave number)
g Name of Sexton or Person in Charge o ises ^�
tA
lease print)
W Signature Title 4'r� )4
DOH-1555(07/18)p 1 of 2
4 r
6s..,3I_'
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#