Fischer, Rose NEW YORK STATE DEPARTMENT OF HEALTH , 1
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Rose Marie Fischer I Female
Date of Death Age If Veteran of U.S. Armed Forces,
February 25, 2011 92 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death X Natural Cause Accident Homicide Suicide Undetermined n Pending
tii Circumstances Investigation
us• Medical Certifier Name Title
9. E.Pallis,MD
Address
Glens Falls,NY
Death Certificate Filed District Number Registerriber
City, Town or Village Glens Falls,NY I 5601
❑Burial Date Cemetery or Crematory
March 1, 2011 Pine View Crematory
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12801
Date Place Removed
Z Removal and/or Held
and/or Address
co Hold
0 Date I Point of
N I I Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
I
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan& Denny Funeral Home 01464
Address
53 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
M Remains are Shipped, If Other than Above
X Address
ird
Mt
W.
Permission is hereby granted to dispose of the human remains descri ed' ve ab inddi
Date Issued Q Z&' // Registrar of Vital Statistics 2 / r L yt,
(signature)
District Number 5601 Place Glens Falls,NY
I certify that the remains of the decedent identified above were dis osed of in accordance with this permit on:
Z /�
W Date of Disposition 3-2-t Place of Disposition 1A.V,,t,�., Cry far<<n..1
2 (ad//dress)cm
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fn `��l , Cq r1
r' (section) (tot�`'mber) (grave number)
pName of Sexton or Person in Charge of Premises t.STi f�,,. J entit
Z ( (please print)
Signature Z1/41,14, 4, Title Z IM4-1 U(--
(over)
DOH-1555(02/2004)