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Fisher, Maria Josephine Ifz11 ter, NEW YORK STATE DEPARTMENT OF HEALTH iv *0 T Burial - Transit Permit Bureau of Vital Records .\ Name First Middle Last Sex Maria Josephine Fisher Female Date of Death Age If Veteran of U.S.Armed Forces, 03/26/2023 84 Years War or Dates14.111111 • Place of Death Hospita Institution or City,Town or Village Queensbury Town Street Address 39 Longview Drive 228,Queensbury Town,New York 12804 Manner of Death Natural Cause Accident Homicide Suicide Undetermined ri Pending Circumstances Investigation Medical Certifier Name Title Shannon Evellis PA ' Address 9 Carey Road,Queensbury Town,New York 12804 • Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 46 1 Burial Date Cemetery,Crematory or Facility Name 03/28/2023 Pine View Crematory • Entombment Address • ©Cremation Queensbury,New York t, ❑Donation ,i, Removal Date Place Removed and/or and/or Held Hold Address 'Transportation Date Point of ESby Common Shipment fli< Carrier Destination - Disinterment Date Cemetery Address 11 L 31 Date Cemetery Address Reinterment " Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 • Address k, 407 Bay Rd,Queensbury,New York 12804 wName of Funeral Firm Making Disposition or to Whom 1)1 Remains are Shipped,If Other than Above Address Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/28/2023 Registrar of Vital Statistics Caroline.7fi&degarde Barber(ECectronicaltySigned) F a (signature) ni ? District Number 5657 Place Town Of Queensbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition 31 Zq 113 Place of Disposition 17„-°V,•_ /.X'0fr a (address) (section) (lot number) (grave number) i, Name of Sexton or Person in Charge of Premises /ir "ft�, se print/ WI SignatuAl, _ Title �� " DOH-1555(07/18)p1 of 2 I . .. Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 le Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#