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Fisher, Louis
..._. ,,LF l alz NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Louis Fisher Male Date of Death Age If Veteran of U.S.Armed Forces, 12/13/2023 73 Years War or Dates F_ Place of Death Hospital,Institution or Z City,Town or Village Moreau Town Street Address 44 Winterberry Lane, Moreau Town, New York 12828 W Manner of Death � W Natural Cause EAccident El Homicide ESuicide FlUndetermined Pending U Circumstances Investigation ILIQ Medical Certifier Name Title John Stoutenburg MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Moreau District Number Register Number City,Town or Village 4562 72 BurialE Date Cemetery,Crematory or Facility Name 12/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 a Date Point of CO❑Transportation Q 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 5 Address CC W 0- Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/15/2023 Registrar of Vital Statistics Brenda.7futter(Electronically Signed) (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: I— Z DispositionDisposition \iN "/ CQC ivv W Date of III FS 3 Place of M 1?"�.i�'1 2 (address) W NCC (section) (lot number) (grave number) c, Name of Sexton or Person in Charge of Pre ises — A,,1-,._ ff Z (please print) r ;1�� W Signature Title ` m�+�^I DOH-1555(07/18)p 1 of 2 . as 7 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on r , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#