Fisher, Gail NEW YORK STATE DEPARTMENT OF HEALTH �, 3
Vital Records Section Burial - Transit*r Permit
Name First Middle Last Sex
GAIL FISHER FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
7/9/2013 69 War or Dates
I-. Place of Death Hospital, Institution
Z City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Ill
p Manner of Death Natural Undetermined Pending
Ili ® Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigation
W Medical Certifier Name Title
C1 JOSEPH MAHON M.D.
Address
43 NEW SCOTLAND AVE ALBANY, NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 1308
Date Cemetery or Crematory
❑ Burial 7/11/2013 PINE VIEW CREMATORY
❑ Entombment Address
Z Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
O ❑ and/or Address
Hold
Cl)
Date Point of
a Transportation Shipment
co' ❑ By Common Destination
111- Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
Permit Issued To Registration Number
Name of Funeral Home SCOTT & BARBIERI FUNERAL HOME 01596
Address
407 BAY ROAD QUEENSBURY, NY 12804
Name of Funeral Firm Making Disposition or to Whom
r. Remains are Shipped, If Other than Above
Address
re
LU
EL Permission is hereby granted to dispose of the human remains described above as indicated.
Date 7/10/2013 Registrar of Vital Statistics d --' '' 1 - 'X £�CP�.�- SK
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
in
Z Date of Disposition 1- 17.-t3 Place of Disposition -;,),40t6%1 £!i"iT4+6fiLL.
w (address)
w
co
CC' (section) (lot n ber) (grave number)
0
w' Name of Sexton or Person in Charge of Premiss i;4 1� �e4
(please print)
Signature4— Title Cjt,uL/hirrd(l.
(over)
DOH-1555 (02/2004)