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Fisher, Joseph Francis 1,40F i NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Joseph Francis Fisher Male Date of Death Age If Veteran of U.S.Armed Forces, 06/29/2023 66 Years War or Dates I.., Place of Death Hospital,Institution or Z City,Town or Village Fort Edward Village Street Address 17 Marion Street, Fort Edward Village, New York 12828 VpManner of Death []Natural Cause []Accident []Homicide Suicide Undetermined []Pending 1 Circumstances f /Investigation LU Medical Certifier Name Title O Charles Yun MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Fort Edward District Number Register Number City,Town or Village 5755 58 Burial Date Cemetery,Crematory or Facility Name 06/30/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 d Date Point of Cl)❑Transportation p by Common Shipment Carrier Destination oDisinterment 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 1— Remains are Shipped,If Other than Above Address CC W C' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/30/2023 Registrar of Vital Statistics Ainee L.AfaIotreygYectronicai2 Signer) (signature) District Number 5755 Place Town Of Fort Edward I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: F- W Date of Disposition 7-/'Za23 Place of Disposition ,/Q vi G 1`� 1�rn, r 2 (address) Ui CC (section) _ (lot number) (grave number) I J O Name of Sexton or Person in Charge Premises . �yftnv^ib woeC' Z (lease print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of '° tis ` *f� delivered on .. , 20, Pine View Cemetery. Representing the funeral home named on burial pepmit Official Funeral Directors Reg.or License# 1 -