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Eisenhardt, Charles NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex -,,„: Charles R Eisenhardt Male , Date of Death Age If Veteran of U.S.Armed Forces, 12/31/2017 87 Years War or Dates Place of Death Hospital, Institution or City, Town or Village Saratoga Springs Street Address Saratoga Hospital Manner of Death©Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined El❑Pending Circumstances Investigation Medical Certifier Name Title Todd Duthaler DO Address we. 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed District Number Register Number City,Town or Village Saratoga Springs 4501 668 ; ❑Burial Date Cemetery or Crematory .,P 01/03/2018 Pine View Crematory ❑Entombment Address ,� ®Cremation Queensbury, New York Date Place Removed Removal and/or Held µ and/or Address Hold Date Point of ❑Transportation Shipment -;„• by Common Destination Carrier Disinterment Date Cemetery Address u.. ❑Reinterment Date Cemetery,-Raoress-- — — �.. �,— -- W. Permit Issued to Registration Number ", Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address , 53 Quaker Rd,Queensbury,New York 12804 ti Name of Funeral Firm Making Disposition or to Whom -• Remains are Shipped, If Other than Above Address vo Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 01/03/2018 Registrar of Vital Statistics John 2'Eranck(Electronically Signed) (signature) District Number 4501 Place Saratoga Springs, New York _, , I certify that the remains of the decedent identified above were disposed of in rdance with this permit on: Date of Disposition / l (address)Zb/(Place of Disposition 0 �Yu�-� 4 �� , ij, l ri Midgn,*1 Z 6-E / (sects (lot number) (grave number) 7.7• Name of S on or Person in Charge of Premises 4 4,0 re L- PA T f � � (plea a print) , Tr Signature MMQ Title (over) DOH-1555(02/2004)