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Fisher Sr., James Glenroy it NEW YORK STATE DEPARTMENT OF HEALTH Burial - 7 Bureau of Vital Records Transit Permi Name First Middle Last Sex James Glenroy Fisher Sr. Male Date of Death Age If Veteran of U.S.Armed Forces, 01/11/2022 89 Years War or Dates 1951-1954 ZPlace of Death Hospital,Institution or !!J City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death © Natural Cause ❑Accident IDHomicide ❑Suicide ❑Undetermined ❑Pending W V Circumstances Investigation Ili D Medical Certifier Name Title Mathew Varughese DO Address 100 Park St,Glens Falls,New York 12801 Death—Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 30 ❑Burial Date Cemetery,Crematory or Facility Name 01/12/2022 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation ZO ❑Removal Date Place Removed H and/or and/or Held (75 Hold Address 0 d 1-1 Date Point of () ❑Transportation p by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment Date Cemetery Address ❑Reinterment 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 F.. Remains are Shipped,If Other than Above 5 Address CC ILLI O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/12/2022 Registrar of Vital Statistics Megan Wolin(ECectronicafTy Signed) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH W Date of Disposition 1//t j 127 Place of Disposition (address) W CC (section) (lot number) (grave number) 0 Name of Sexton or Person in Charge of P ises i,‘r L. ,,,l tT Z (/Tease yl print) � RISi nature Title l'is If DOH-1555(07/18)pi of 2 y= _ pp 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'_#... • Town of Queensbury Certification of Cremation s � Pine View Cemetery and Crematory This certifies that the remains of: James Fisher Sr. were cremated on January 14 20 22 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death January 11 20 22 Age 89 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 47 RJ (Authorized Signature) FISHER NAME James Fisher Sr. ..7) Age: 89 Lot Owner: James & Peggy Fisher Sr. Lot# Oneida Crypt Grave# Case: Urn Died: 1 . 1 1 .2 2 Interred: 1 0.8.2 2 • Funeral Home: Baker FH Cemetery: Pine View FISHER y .♦ � V 155,156,157, (j4!) 6 Lot No. 1 Y,1G2,175 Address 2 Garner St., Glens Falls, N.Y. Sections Nttk• Owner James G. Fisher Sr,,& Peggy J. Fisher Plot Oneida_ Date 7/27/77 600 Superficial ft. @ $2.50 per sq. ft. Location Bounded on the North by Path, East by Path, South by Savale,Bowman, Fitzgibbon, West by Road, Savale & Bowman Corner Posts Remarks The Deed listed below replaces Deeds #1408 & 1416 which have been voided. Deed No. (and changes) 1)1)15 Payment Record Paid in full 7/27/77 . 1 Form No. 01 Record of Interments 1 I So Mc.5 Cr Skc.e. Se. /0./O- Oa S 2ccl9/ FS /U - /. 2- 0D 6 3 I ,I-C20-k- F15 kc,c .2---e - Lo- 7. 7'7 7 1 c-/fhi-�Zmm-m' 1-"'/S1EiE) (?1-1. 2 4 1 18 I r)21 4‹'X . ..41Ylc.5 Ai i.___________________ .4C i T7/9 -r7/ I w p -_. , / _ a o 1_17\7 6 X \_)( \ � v 1 ``ter I /G .. 1 . . I . 4 41 1 I, S R-.5