Fischer, William 4tsg
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
William Fishner Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 21, 2014 81 War or Dates
Place of Death Hospital, Institution or
Z City, Town or Village Glens Falls Street Address Glens Falls Hospital
• Manner of Death n Natural Cause Li Accident n Homicide n Suicide n Undetermined n Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Daniel Way MD
Address
100 Park Street,Glens Falls,NY 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 3 g
❑Burial Date Cemetery or Crematory
January 22,2014 Pine View Crematorium
❑Entombment Address
❑x Cremation 51 Quaker Road, Queensbury, NY 12804
Date Place Removed
ZZ n Removal and/or Held
and/or Address
H Hold
O Date Point of
Nn Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
n Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
Address
W
a
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued { ( 22- 1 /if Registrar of Vital Statistics �C _0 ' "'"
(signatur
District Number 5601 Place Glens Falls ) /AV
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z '
W Date of Disposition I h1)1(1 Place of Disposition ff.( kigii,j tur„A.,'
2 (address)
W
(section)
Cl) lot numb (grave number)
j
Name of Sexton or Person in Charge of Premises /41Jl r th«+
Z / II(please print)
LiuSignature itj Title 671 Opt.
(over)
DOH-1555(02/2004)