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Fitzgerald, Terry Joseph 333 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Terry Joseph Fitzgerald Male Date of Death Age If Veteran of U.S.Armed Forces, 04/25/2023 75 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital WManner of Death El Natural Cause Accident Homicide ESuicide Undetermined ri Pending V Circumstances Investigation ILI 0 Medical Certifier Name Title Paul Marra Coroner Address 112 State Street,Albany, New York 12207 Death Certificate Filed City Of Albany District Number Register Number City,Town or Village 0101 1017 Burial Date Cemetery,Crematory or Facility Name 04/29/2023 Pine View Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation O❑Removal Date Place Removed and/or and/or Held H Hold Address 0 a. Date Point of (I) Transportation p by Common Shipment Carrier Destination LIDisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom • H Remains are Shipped,If Other than Above a Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 04/28/2023 Registrar of Vital Statistics Danielle S Gi((espie(E(ectronicallySigned) (signature) District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 4/-2 9 taj 5 Place of Disposition „12 �.>✓ ( ' ein���� 2 (address) W CC (section) ' (lot number) (grave number) GName of Sexton or Person in Charge of P mise �\ a Y�tIO J �V/aD el Z (please print) W Signature ` A Title Or 17-4.40� DOH-1555(07/18)p 1 of 2 I E..-y • 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#