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Schussler, Robert NEW YORKSTATE DEPARTMENT OF HEALTH s Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Schussler Male Date of Death Age If Veteran of U.S.Armed Forces, ?"' 04/05/2020 57 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Hempstead Town Street Address Nassau University Medical Center J3 Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending V Circumstances Investigation UJ Medical Certifier Name Title Balamsia Golo Address 2201 Hempstead Tpke,Hempstead Town, New York 11554 Death Certificate Filed District Number Register Number City,Town or Village Hempstead 2950 02344 ❑Burial Date Cemetery,Crematory or Facility Name 05/07/2020 Pine View Crematory R+, Entombment Address Cremation Queensbury,New York Donation zFjRemoval Date Place Removed and/or and/or Held F—asHold Address p a Date Point of N ❑Transportation p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home NEW LEAF CREMATION 02058 Address 3930 LONG BEACH RD., ISLAND PARK,New York 11558 Name of Funeral Firm Making Disposition or to Whom _H Remains are Shipped,If Other than Above Address c W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/06/2020 Registrar of Vital Statistics xath(een Murray(ECectronicaCCy Signed (signature) District Number 2950 Place Hempstead, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I-- WDate of Disposition = o�ZV Place of Disposition ,� A,Q 2 (address W (A (section) (lot number) (grave number) SName of Sexton or Person in Ch a of rem I +a � /p ease print/ IiJ Signature Title r DOH-1555(o7%8)p 1 of 2 Public Health Law Sec. 4145(2b) 13 7 Receipt Human remains of delivered on , 20 1 Pine'View Cemetery Representing the funeral home named on,burial permit Official Funeral Directors Reg.or License#