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Fish, Robert E. NEWYORK STATE DEPARTMENT OF HEALTH Burial - Transit Permi Bureau of Vital Records Name First Middle Last Sex Robert E Fish Male Date of Death Age If Veteran of U.S.Armed Forces, 11/22/2019 77 Years War or Dates 1960-62 Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 48 Mechanic Street, Fort Edward Village, New York 12828 13 Mannerof Death ©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending LU U Circumstances Investigation 1U Medical Certifier Name Title Rita All NP Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed District Number Register Number City,Town or Villa a Fort Edward ---T5755 gg ❑Burial Date Cemetery,Crematory or Facility Name ❑Entombment 11/27/2019 Pine View Crematory Address FKCremation Queensbury Town,New York ❑Donation 0 ❑Removal Date Place Removed and/or and/or Held H N Hold Address O CL ❑Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address 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 F— Remains are Shipped,If Other than Above 2 Address M W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/26/2019 Registrar of Vital Statistics fgimeeWahoney(ECectronicadySiyned) (signature) District Number 5755 Place Fort Edward, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H II Z Date of Disposition 12/q 15 Place of Disposition ��ViJ �i 40r„ W 2 (addressl W IX (section) (lotnumber) (grave number/ 93 Name of Sexton or Person in Charge of Premises A-3ilL Zr �/Q (pt se print) W Signature Title �(LF DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 01312 Receipt Human remains of delivered on , 20_ Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#