Loading...
Taylor, Dale Madison NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Dale Madison Taylor Male Date of Death Age If Veteran of U.S.Armed Forces, 02/14/2023 86 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation UJ 'p Manner of Death ❑X Natural Cause Accident El Homicide OSuicide 111Undetermined riPending 0 Circumstances Investigation W Medical Certifier Name Title a Courtney Diamond NP Address 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 84 Burial Date Cemetery,Crematory or Facility Name 02/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held F- Hold Address 0 a Date Point of N❑Transportation Shipment 5 by Common Carrier Destination Disinterment Date Cemetery Address EIReinterment 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 I.. Remains are Shipped,If Other than Above a Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/15/2023 Registrar of Vital Statistics Megan No(in(ECectronica1Ty Signed) (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: Z Date of Disposition 2 j i 6 I l Place of DispositiontU 2 (address) W CC N (section) / (lot number) (grave number) 8 Name of Sexton or Person in Charge of Premi At ease print/ W Signature Title OT''014170? DOH-1555(07/18)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# " _