Fish, Aaron M NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit y,LJ
Bureau of Vital Records
Name First Middle Last Sex
'! Aaron M.Fish Male
r Date of Death Age If Veteran of U.S.Armed Forces,
05/17/2022 64 Years War or Dates
F. Place of Death Hospital,Institution or
`uZ� City,Town or Village Glens Falls Street Address Glens Falls Hospital
W Manner of Death []Natural Cause []Accident []Homicide []Suicide Undetermined Pending
Circumstances Investigation
I Medical Certifier Name Title
O Kyle Leonard MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 277
Burial Date Cemetery,Crematory or Facility Name
05/20/2022 Pine View Crematory
Entombment Address
itw.
OLLICremation Queensbury Town,New York
Donation
O El Removal Date Place Removed
and/or and/or Held
H Hold Address
N
0
0 Date Point of
[]Transportation Shipment
by Common
Carrier Destination
•
Date Cemetery Address
[]Disinterment
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
I., Remains are Shipped,If Other than Above
5. Address
IX
at
p" Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 05/20/2022 Registrar of Vital Statistics Megan Nolin(E(ectronicalry 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:
h-
Z Date of Disposition 51--2j-22/Z Place of Disposition T,'.,,7e Vi.e,� C t—lo :ILU (a dress)
LU
N' (section) h (lot number) (grave number)
re v
0 Name of Sexton or Person in Cha e of Premis l��/ylaN OVA
Z / I (please print)
W Signature " <'� Title DP�J�.4--5
DOH-1555I (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# l"