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Fisk, Donald F Slb NEW YORKSTATE DEPARTMENT OF HEALTH • • Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Donald F.Fisk Male Date of Death Age If Veteran of U.S.Armed Forces, 09/22/2021 92 Years War or Dates 1950-1954 Place of Death Hospital,Institution or Z City,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare 'p Manner of Death © Natural Cause El AccidentEl HomicideEl Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title CI Leonard Gelman MD _ Address 4573 State Route 40,Argyle Town,New York 12809 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 61 El Burial Date Cemetery,Crematory or Facility Name 09/24/2021 Pine View Crematory Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held NE— Hold Address 0 O. Date Point of fA ❑Transportation p by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/24/2021 Registrar of Vital Statistics Shelley 9Kckernon(ECectronicaCCySigned) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 9a5--2p2 j Place of Disposition g tve u.1.6.41 Ct- 440 6 IA - 2 (address) W CCCC (section) (lot nu ber) (grave number) 8 Name of Sexton or Person in Charge of Premises R 10nii,' " ilk e 1 (please print) W Signature '/-if,' Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt f. Human remains of R " delivered on , 20 • Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#