Fish, Harry E 4- 2LII
NEWYORKSTATEDEPARTMENTOFHEALTH Bu
rial of Vital Records - Transit Permit
Name First Middle Last Sex
Harty E.Fish Male
Date of Death Age If Veteran of U.S.Armed Forces,
03/11/2022 72 Years War or Dates
F, Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
F+ Manner of Death 1:3 Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined ❑Pending
W
V Circumstances Investigation
1111 Medical Certifier Name Title
a Asim Chaudty MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
Cit ,Town or Village 5601 162
Burial Date Cemetery,Crematory or Facility Name
03/18R022 Pine View Crematory
Entombment Address
Cremation Oueensbury Town,New York
Donation
❑Removal Date Place Removed
and/or and/or Held
pN Hold Address
0
fZ Date Point of
N DTran sportatio n
p by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
Date Cemetery Address
DReinterment
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
I— Remains are Shipped,If Otherthan Above
' Address
Q
W
a' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/18/2022 Registrar of Vital Statistics Alvan Iran(EGctrnn Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
WDate of Disposition AI,I zz Place of Disposition .,cvN..... , ram
2 (adi*ess)
W
N
CC (section) !lot number) c (grave number)
SName of Sexton or Person in Charge of Pre ises f/. �.- ,N.Iviir
Z .....a (pi se print)
fL 40142
Signature / TitleY11 —
DOH 1555(07/18)p 1 of 2
1 Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , 20
I
1
1 Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# /