Eckler, Caryl ,
NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
.v.: Caryl S. Eckler Female
• Date of Death Age If Veteran of U.S. Armed Forces,
June 15, 2015 83 War or Dates
▪ Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
r Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Suzanne Blood Dr.
Address
Manor Drive,Queensbury,NY 12804
::::: Death Certificate Filed District Number Register Number
.. City, Town or Village Glens Falls, NY 56017
❑Burial Date Cemetery or Crematory
June 18, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation 21 Quaker Road, Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
F' Hold
N
O Date Point of
NTransportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
:: Name of Funeral Home Regan Denny Stafford Funeral Home 01443
Address
53 Quaker Road, Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
i4; Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
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:..:1 Date Issued t? Registrar of Vital Statistics 6 (�„,.S 1 S j �'klo
r (signature)
District Number 5 6o f Place Glens Falls,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
11,1• Date of Disposition (-a)— (S Place of Disposition 4'n< Ut Y , Cr1,„..4_4 or ,'u nn
w (address)
co
W (section) n (lot number) (grave number)
QName of Sexton or Person in Ch rge of Premises ( tMv4ky (�(0ii.t //e
Z �� (please print)
W
Signature Title Cr<,hc,4-0: 14fS.i
(over)
DOH-1555(02/2004)