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Mercier, Richard Frederick ,T R �I�{.. tt 219 NEW YORK STATE DEPARTMENT OF HEALTH Y Burial -Bureau of Vital Records LFTransit Permit Name First Middle Last Sex Richard Frederick Mercier Male Date of Death Age If Veteran of U.S.Armed Forces, 03/06/2024 83 Years War or Dates I- Place of Death Hospital,Institution or W City,Town or Village Fort Edward Village Street Address 35 Frederick Drive, Fort Edward Village, New York 12828 p Manner of Death El Natural Cause EAccident 0 Homicide Suicide nUndetermined Pending W U Circumstances Investigation Wp Medical Certifier Name Title Agee/Gillani 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 18 Burial Date Cemetery,Crematory or Facility Name 03/07/2024 Pine View Crematory Entombment _ Address • ©Cremation Queensbury Town,New York , ElDonation 0❑Removal Date Place Removed and/or and/or Held H Hold Address CO 0 a. Date Point of V)❑Transportation p by Common Shipment Carrier Destination ElDisinterment 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 i.-. Remains are Shipped,If Other than Above N Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/07/2024 Registrar of Vital Statistics Aimee G ,Ia(toney(ECectronicau(y Signed) (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- 2 Date of Disposition 3ig 1t; Place of Disposition Cr -� M _'I ?IAA/Pr-A-) �'i►, (address) . W CC N (section) 1 (lot number) setNA. (grave number) el Name of Sexton or Person in Charge of Premise At.i)p. It z ase print/ / tL Signature �•�� /V7 Title lK ►iU( DOH-1555(07/18)p 1 of 2 • Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg. or License#_ -