Fisher, Edward NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section _ , Burial - Transit Permit
Name First Middle Last Sex
Edward V Fisher Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 9, 2012 89 War or Dates
Place of Death Hospital, Institution or
'Z City, Town or Village Queensbury Street Address 11 Cobblestone Drive
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Manner of Death X Natural Cause n Accident I I Homicide Suicide Undetermined Pending
tit Circumstances Investigation
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, Medical Certifier Name Title
:9, Mark Hoffman,MD
Address
102 Park Street,Glens Falls,NY 12801 ,
Death Certificate Filed ict Number "R i, ,r Number
City, Town or Village Queensbury SCDc
❑Burial Date Cemetery or Crematory
April 13, 2012 Pine View Crematorium
❑Entombment Address
El Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
and/or Address
r' Hold
V)
0 Date Point of
N I I Transportation Shipment
a by Common Destination
Carrier
I Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
-< Permit Issued to Registration Number
:,,: Name of Funeral Home Regan& Denny Funeral Home 01443
! Address
A 53 Quaker Road, Queensbury,NY 12804
I> Name of Funeral Firm Making Disposition or to Whom
1 Remains are Shipped, If Other than Above
Address
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Eke Permission is hereby granted to dispose of the human r ins described above as indicated.
Date Issue 1 . sG Registrar of Vital Statistics Ck - rt..L
(signature)
District Number c--) Place Queensbury
I—
I certify that the remains of the decedent identified above were'disposed of in accordance with this permit on:
gDate of Disposition q/i IIZ Place of Disposition t'�rCVkv 6/"`to(u•--
P;L W (address)
1 U) .e
re
tr-4 0 (section) �l _ (lot nu er) (grave number)
p Name of Sexton or Perso in CALharge f Premises .. -, folk ch,4H-
Z (please print)
W
Signature Title CIQEt1 isciA.
(over)
DOH-1555(02/2004)