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Eichler, David Robert Cedric NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex David Robert Cedric Eichler Male Date of Death Age If Veteran of U.S.Armed Forces, 11/30/2019 35 Years War or Dates H Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 14 Grand Street,Glens Falls, New York 12801 p Manner of Death Natural Cause Accident Homicide Suicide ❑Undetermined ©Pending u! Circumstances Investigation W Medical Certifier Name Title C) Timothy Murphy Coroner Address 52 HAVILAND AVE,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Villa a Glens Falls 5601 519 Burial Date Cemetery,Crematory or Facility Name 12/04/2019 Pine View Crematory Entombment _Address~ X❑Cremation Queensbury Town,New York Donation z Removal Date Place Removed O and/or Held and/or N Hold Address O 0. Date Point of !A Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom IF-+ Remains are Shipped,If Other than Above g Address W I' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/02/2019 Registrar of Vital Statistics &bert,4ndrew Curtis(Electronically Signer (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: H W Date of Disposition IZ jq 119 Place of Disposition l n� ot10— Uj (address) W CO) (section) AA�6/- 0 (iotnumber) /grave number/ O - Name of Sexton or Person in Charge of Premises S�a(p/e e print) LLI Signature — Title �kMq DO H-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 0131.22 r Receipt Human remains of ' + y delivered o4 : ! '` , 20 Pine View Cemetery Representing ie funer"ome named on burial permit Official Funeral Directors Reg.or License# f