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Fisher Jr, William NEW YORK STATE DEPARTMENT OF HEALTH . t, (3 Vital Records Section . I Burial - Transit Permit Name First Middle Last Sex William Fisher Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, September 15,2006 78 War or Dates F— Place of Death City of Glens Falls Hospital, Institution or Glens Falls Hospital Z City,Town or Village Street Address WW Manner of Death © Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending Circumstances Investigation tW Medical Certifier Name Titt W k kr gels A vi.c.o r2G ( PCNee-. 0 Address G"-70 ,S'Tw-if 12 r kA-1,iT L,4,i-, of 9 Death Certificate Filed District Number RepisteM Num er City,Town or Village Glens Falls 5601 •'55(( 5 ❑ Burial Date Cemetery or Crematory 9/18/2006 Pine View Crematorium ❑ Entombment Address Q Cremation Queensbuiy,NY Date Place Removed z 0 Removal , and/or Held • and/or Address H Hold Date Point of O ❑ Transportation Shipment _. by Common Destination G Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Home Q/S/9 Address 53 Quaker Road,Queensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above g Address ir 00_ Permission is hereb granted to dispose of the human remains described e i .—,,: � � Date Issued �rj'j8/D� Registrar of Vital Statistics (signature) District Number 5601 Place Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WW Date of Disposition c1 A$ /a L Place of Disposition e,,,r.,,r n� -riart, o(r (address) W c (section) (1gt number) (grave number) • Name of Sexton or Person in Charge of Premises C L J.,h+ie d- O (please print) W Signature / L Title Crc�c,fite(— DOH-1 555 (02/2004) (over)