Fischler, Edward 08/18/2014 1E:25 15185687041 iiir1 VINCET A ENEA PAGE 01
NEW YORK STATE DEPARTMENT OF HEALTH # 5--
Vital Records Section Burial - Transit Permit
Name First Edward Middle Fischiter Sex
Male
Date of Death A e— ! If Veteran of U.S..-Armed Forces, —"-'�
August 16, 2014 51 War or Dates No 1. Place of Death Hospital. Institution or w. '
XRy, Town 61,0411Hirg Danube Street Address Indian Castle Rest Area
Manner of Death❑Natural Cause ❑Accident Li Homicide fl Suicide Undetermined f Pending
I Circumstances Investigation
Medical Certifier Name Title
dd Vincent A. Enea_ __ Coroner
,. .... .r.� Ak:res s Box 9 Hexkimer, NY 13350�
Death Certificate Filed District Number ` Register Number
(filly, Town pedgillagiK Danube 2151 3
[]Burial Date Cemetery or Crematory
August 19, 2014 Pine View Crematory
[]Entombment'Address
®Cremation Queensbury• NY
__._.. __ Date _r r- ..�.... Place' Removed v ._
D Removal j and/or Held
and/or Address
Hold
Date ; Point of
Li Transportation �w.. . .. Shipment _
_ by Common Destination
Carrier .
[�Disinterment Date I Cemetery Address "J
f
—
C1 Retnterment Date Cemetery Address
Permit Issued to Regan & Denny Funeral Haase Registration Number
Name of Funeral Home , 01444
Address
94 Saratoga Ave., South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
iRemains are Shp , If Other than Above
Address
Permission is hereby granted to dispose of the human remains d scribed abo a as indicated.
Date Issued 08/18/2014 Registrar of Vital Statistics (1 —
District Number 1 5 Place Town of Danube,
'"" I certify that the remains of the decedent identified above were disposed of in accordance with this permit on;
E
iii: Date of Disposition t i Ills/ Place of Disposition ‘,:b()t alw10P;.,.
(address)
til
(section) ? (lot number) (`' (grave number)
. , Name of Sexton or Person in Charge of Premises `{/nr„tQLcf JCNorif
di (please print)
Signature It; Title co.*er
(over)
DOH-1555 (02/2004)