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Fisk, Carol A - s LF NEWYORKSTATEDEPARTMENTOFHEALTH di Chit; ` _ Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol A.Fisk Female Date of Death Age If Veteran of U.S.Armed Forces, 11/14/2023 86 Years War or Dates 1— Place of Death Hospital,Institution or W City,Town or Village Granville Town Street Address Slate Valley Center for Rehabilitation and Nursing p Manner of Death ❑X Natural Cause lilAccident El HomicideSuicide IllOndetermined Pending Circumstances Investigation W Medical Certifier Name Title O Joshua Started NP Address 10421 State Route 40,Granville Town,New York 12832 Death Certificate Filed Town Of Granville District Number Register Number City,Town or Village 5756 66 Burial Date Cemetery,Crematory or Facility Name 11/16/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation g Removal Date Place Removed and/or and/or Held H Hold Address N 0 O. Date Point of U)El Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom F— Remains are Shipped,If Other than Above 2 Address Et W CI. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/16/2023 Registrar of Vital Statistics .7enny Linda. L9Warte8 'i' ectronica(Signed (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 2 W Date of Disposition II iltP I Z3 Place of Disposition PT u!`v:F 0) f)2F awi7t(23„` 2 (address) W CC (section) dv__(lot number) (grave number) 0 Name of Sexton or Person in Charge of Premises nt ase print) Z W Signature7 Title C06 fiH M. DOH-1555(07/18)p 1 of 2 )17666 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#