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Fitzgerald, Joseph Frederick .49 .t sus NEW YORK STATE DEPARTMENT OF HEALTH" Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Frederick Fitzgerald Male Date of Death Age If Veteran of U.S.Armed Forces, 07/10/2023 63 Years War or Dates F,., Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 210 White Birch Estates,Moreau Town,New York 12828 LIJ p Manner of Death 0 Natural Cause Accident 0 Homicide Suicide Undetermined Pending LU I I Circumstances I 'Investigation U W Medical Certifier Name Title 0 Christopher Mason DO Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 36 Burial Date Cemetery,Crematory or Facility Name 07/12/2023 Pine View CrematoryEntombment Address "\ ©Cremation Queensbury Town,New York Donation Date Place Removed ZO Removal and/or Held I- - and/or (AHold Address il aDate Point of doe' N❑Transportation Shipment Q by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 5 Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/11/2023 Registrar of Vital Statistics Brenda.7futterglectronicallySrgnea) (signature) District Number 4562 Place Town Of Moreau I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition 1 IP/(Z3 Place of Disposition `t �,_LI. /*_. W (address) W Cl)CC (section) Q(lot number) (grave number) 0 Name of Sexton or Person in Charg f Premises 0 se print) (p W Title i(t L/✓r1 it; Signature DOH-1555(07/18)p 1 of 2 1 � . t a-.1 A 711.4 I Public Health Law Sec. 4145(2b) Receipt s 4 Human remains of delivered on , 20 Z. Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#