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Fish, Tammy D
2/1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Tammy D.Fish Female Date of Death Age If Veteran of U.S.Armed Forces, 03/03/2023 59 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Hudson Falls Village Street Address 289 Coleman Ave, Hudson Falls Village, New York 12839 O Manner of Death ❑� Natural Cause Accident Homicide Suicide Undetermined El Pending 111 Circumstances Investigation • Medical Certifier Name Title O Aqeel Gillani MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 6 Burial Date Cemetery,Crematory or Facility Name 03/07/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York DDonation 6❑Removal Date Place Removed and/or and/or Held Hold Address 0 d Date Point of (/)❑Transportation Q by Common Shipment Carrier Destination oDisinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above a Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/06/2023 Registrar of Vital Statistics Cynthia cBardin(ECectronica(CySigned) (signature) District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 3 h I Z Place of Disposition 4)tdr•--- 2 (address) W CC (section) A (lot number) (grave number) Name of Sexton or Person in Charge of Premises AN i9--- 5'` 11 (pease print) W Signature Title lttinl'trz � DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) f Receipt Human remains of delivered on , 20 Pine View Cemetery ' Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#