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Fisher, Ada Mae
NEW YORK STATE DEPARTMENT OF HEALTH J Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Ada Mae Fisher Female Date of Death Age If Veteran of U.S.Armed Forces, 03/11/2023 92 Years War or Dates r- Place of Death Hospital,Institution or WCity,Town or Village Fort Ann Town Street Address 34 Catherine Street, Fort Ann Town,New York 12827 p Manner of Death El Natural Cause Accident 0 Homicide El Suicide Undetermined ElPending W U Circumstances Investigation W Medical Certifier Name Title G Melanie Duerr NP Address 47 Tom Phelps Lane,Mineville Hamlet,New York 12996 Death Certificate Filed Town Of Fort Ann District Number Register Number City,Town or Village 5754 6 Burial Date Cemetery,Crematory or Facility Name 03/16/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ZO❑Removal Date Place Removed and/or and/or Held I- - Hold Address CO 0 O. Date Point of N ETransportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 -. Remains are Shipped,If Other than Above 2 Address CC ILLJ a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2023 Registrar of Vital Statistics 9itiranda7ferringslzaw(Erectronicalry Signed) (signature) District Number 5754 Place Town Of Fort Ann I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— ' V Z Date of Disposition ,3 izo I 7 3 Place of Disposition �K 2 (address) fill CO (section) I-A (lot number)—C (grave number) Name of Sexton or Person in Charge of Premiss M Z ,Tease print) / ILI Signature Title (ir✓ Triy DOH-1555(07/18)p 1 of 2 1 - L, 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 � � Pine View Cemetery and Crematory This certifies that the remains of: Ada Mae Fisher were cremated on March , 20 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death March 11 20 23 Age 92 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 256 (Authorized Signature) FISHat. • 1 ( 140) Lot NO. 142) Address 127 4th St. Ext., Glens Falls, N.Y. Section Na.. Owner Kenneth D. Fisher Plot Oneida -- 22_2- 20 -E' • Date 11/19/76 300 Superficial ft. @ $2.50 per sq. ft. Location Boded on the North bynVaca.nt. East by Path, South by Path& Fisher, West by Road Corner Posts Remarks Deed No. (and changes) 1/109 Payment Record Paid in full 11/19/76 (t7/(•C'll..6) • c)--upt, r _ •0-1 c-7 6-1/1 • Limmigoimmippopipp.wm. Form No. 01 Record of Interments 1 . 5 1146,4-i cs g•i ske.t. /- 3 m-7.i .0-z) 03-6 ,40 A 1 6 William M. Fisher 11/6/95 -3X1 Kenneth D . Fisher 7/11/00 7 4 Charles Fisher 8/17/90 8 I Pn 7 9 i . c.> 4.(• f , ,/ t :$ A • 7j. • AL .1.46.1:- I • —77/ y 1 - f 0 ' • ("- 0 A FISHER NAME ADA Mae Fisher Age: 92 Lot Owner: Kenneth D. Fistier Lot# Oneida 140 141 142 Grave# 3B Case: Urn Died: 3. 1 1 .2 3 Interred:7.3.2 3 Funeral Home: Baker FH Cemetery: Pine View