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Fisher,Anthony Scott NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Anthony Scott Fisher Male Date of Death ge If Veteran of U.S.Armed Forces, 05/09/2020 15:5 Years War or Dates ZPlace of Death Hospital,Institution or Uj Z City,Town or Village Glens Falls Street Address 165 Maple Street,Glens Falls,New York 12801 p Manner of Death ©Natural Cause Accident Homicide Suicide Undetermined Pending W C.) Circumstances Investigation LLJ Medical Certifier Name Title Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed DDDistrict Number Register Number City,Town or Village Glens Falls 601 208 Burial Date Cemetery,Crematory or Facility Name 05/12/2020 Pine View Crematory Entombment Address AjCremation Queensbury Town,New York Donation z1:1 Removal Date Place Removed F„ and/or and/or Held N Hold Address O a Date Point of to1:1 Transportation p by Common Shipment Carrier Destination Disinterment 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 orto Whom F— Remains are Shipped,If Other than Above Address c W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/11/2020 Registrar of Vital Statistics Wybert,4ndrew Curtis(ECectronicaQySWned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H Z Date of Disposition s1 Iq�`ZV Place of Disposition 11 r.� fill 2 (address) W N cr (section) (tot number) (grave number) 8 Name of Sexton or Person in Charge of Premises n Z -e (plea print) LU Title Signature r� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) _3 8 13 F) Receipt Human remains of delivered on , 20 Pine,-,Aew Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#�