Fischer, John NEW YORK STATE DEPARTMENT OF HEALTH i e85—
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
John Thomas Fischer Male
Date of Death Age If Veteran of U.S. Armed Forces,
January 30, 2014 59 War or Dates N/A
f4 Place of Death Hospital, Institution or
Z City, Town or Village Northumberland Street Address 36 Baker Dr.
lai
0 Manner of Death®Natural Cause Accident Homicide 0 Suicide Undetermined Pending
Circumstances Investigation
at Medical Certifier Name Title
Rodney Ying Doctor
Address
59 Myrtle St., Saratoga Sp. NY 12866
Death Certificate Filed District N,u4n Register Nu ber
>' City, Town or Village Northumberland �
❑Burial Date Cemetery or Crematory
02-03-2014 Pine View Crematory
s;❑Entombment Address
``;®Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Removal and/or Held
and/or Address
Hold
Date Point of
siQ Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address! El
Reinterment Date Cemetery Address
n Liigi Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 00364
Address
402 Maple Ave., Saratoga Sp. NY 12866
M. Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
gr
Ili
Permission is hereby granted to dispose of the human re ains described above as indicat .
0. Date Issued ( )D c.,A)tk--\ Registrar of Vital Statistics
(signs e) J
District Number y - Place \oLso'� 0 1 VCR V „i,Yl CX ' c^ 1
I certify that the remains of the decedent identified above disposed of in accordance with this permit on:
Iii Date of Disposition Vigil/ Place of Disposition ,I‘t 14;i.1 Cis dn.`-
II (address)
U)
CC (section) (lot umber) (-'" (grave number)
Ci Name of Sexton or Perso ' Charge of Premises -. tt, r Je WO
Z / ( ease print)•
Signature , /t��r Title Cecaityra6
(over)
DOH-1555 (02/2004)