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Fish, Ramon Raleigh • NEW YORK STATE DEPARTMENT OF HEALTH At Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Ramon Raleigh Fish Male Date of Death Age If Veteran of U.S.Armed Forc- , 12/06/2021 82 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Indian Lake Town Street Address 5275 30 Route, Indian Lake Town,New York 12842 p Manner of Death © Natural Cause ❑Accident Homicide ❑Suicide ❑Undetermined Pending lil Circumstances Investigation W• Medical Certifier Name Title O Anne Evans DO Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Indian Lake 2053 14 ❑Burial Date Cemetery,Crematory or Facility Name 12/08/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation O Removal Date Place Removed and/or and/or Held p Hold Address 0 a Date Point of V) 1-1 Transportation by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 6357 Nys Rte#30, Indian Lake,New York 12842 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/08/2021 Registrar of Vital Statistics Julie A Clawson(Electronically Signed) (signature) District Number 2053 Place Indian Lake, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: WDate of Disposition ftr"rohi Place of Disposition 2 (address) W CC (section) (lot number) Si‘ (grave number) g Name of Sexton or Person in Charge of Premises ' Z (pleas print) / �� 111 Signature Z Title G��M' t"'�� DOH-1555(07/18)p t of 2 1. 5 423 .� d Public Health Law Sec. 4145(2b) Receipt Human remains of 20 delivered on is Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#