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Fifield, John P
400 NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex John P Fifield ' Male Date of Death Age If Veteran of U.S.Armed Force/ 07/24/2023 51 Years War or Dates F. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LIU O Manner of Death a Natural Cause Accident ❑Homicide El Suicide nUndetermined ❑Pending IliCircumstances Investigation W• Medical Certifier Name Title CI Sean Bain MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 354 HBurial Date Cemetery,Crematory or Facility Name 07/27/2023 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 U)ElTransportation Shipment p by Common Carrier Destination ODisinterment Date Cemetery Address ElReinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Edward L Kelly Funeral Home 00519 Address PO Box 548,Schroon Lake,New York 12870 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 07/26/2023 Registrar of Vital Statistics .legan.9lrolrn(EYectranical''Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 7 I n 173 Place of Disposition '6, u._.. .4.7F--- W (address) W N (section) I(lot number) (grave number) fr E • Name of Sexton or Person in Charge of Pre l� `t k- Z (p! se print) W Signature Title rric/h . .1 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 I Pine View Cemetery Representing the funeral home named on buriAl permit Official Funeral Directors Reg.or License#