Fisher, Peggy Joyce Zo
NEW YORK STATE DEPARTMENT OF HEALTH Burial.- Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Peggy Joyce Fisher ' Female
Date of Death Age If Veteran of U.S.Armed Forces,
01/03/2021 85 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 2 Garner Street,Queensbury Town,New York 12804
W
• Manner of Death II Natural Cause Accident El Homicide ❑Suicide ID Undetermined El Pending
V Circumstances Investigation
W Medical Certifier Name Title
CI Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City,Town or Village Queensbury 5657 3
IDBurial Date Cemetery,Crematory or Facility Name
01/05/2021 Pine View Crematory
❑Entombment Address
0 Cremation Queensbury Town,New York
ElDonation
O• ElRemoval Date Place Removed
and/or and/or Held
F- Hold Address
0
a Date Point of
Cl) ❑Transportation
ES Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Ui
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/05/2021 Registrar of Vital Statistics Carolinexkfegarf Barb-er(Electronicall6,Sfgned)
(signature)
District Number 5657 Place Queensbury, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition I(7 I'el Place of Disposition IN--
2 (address)
W CC
(section) I lort numbe� r) "'4t (grave number)
O Name of Sexton or Person in Charge � �of Premises
(pleas;print)
ifide
Signature , Title r '.�
DOH-1555(07/18)p t of 2
Public Health Law Sec. 4145(2b) 014364
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#