Fisk, Madeline Marie NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Madeline Marie Fisk Female
Date of Death Age If Veteran of U.S.Armed Forces,
11/25/2021 88 Years War or Dates
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 Accident El HomicideSuicide Undetermined Pending
Circumstances Investigation
• Medical Certifier Name Title
O Joshua Starteri NP
Address
4573 State Route 40,Argyle Town,New York 12809
Death Certificate Filed District Number Register Number
City,Town or Village Argyle 5750 71
❑Burial Date Cemetery,Crematory or Facility Name
11/30/2021 Pine View Crematory
❑Entombment Address
lCremation Queensbury Town,New York
ElDonation
Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
a Date Point of
U ❑
) Transportation
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
El 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
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 11/29/2021 Registrar of Vital Statistics Shelley!Mckernon(Electronically Signed)
(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 J/30--tt1Z Place of Disposition e T1 Cr
(address)
W
CC CC (section/ (lot numbe (grave number)
SName of Sexton or Person in Ch a of Pre ises J m 041 tJevri
�3�� (please print)
W L �—
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#