Eckhoff, Adelaide NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Biostatistics-Vital Records Section
>: Name First Middle Last Sex
Adelaide Eckhoff Female
Date of ......... ......
............................................................
..
............_._................. _._.........__....:.:.:::. :.........:.
a Death Age If Veteran of U.S.Armed Forces,
11-12-88 66 War or Dates No
;$ Place of Death Hospital, Institution or
W...City,Town or Village.Town of Bolton Landing ; Street Address Sagamore Road
.. .. ......... ......... ........
Cause of Death
Pleural and Pulmonary Metastatic Disease
Medical Certifier Name Title
>L7 Mark Hoffman Medical Physician
Address ::.......................................................................................................................................................................................................
88 Broad Street, Glens Falls, NY 12801
.... : ..... ..... ....... ............ ................... .....Death Certificata ......................
Filed District Number Register Number
City,Town or Village Town of Bolton Landincj
Date Cemetery or Crematory
❑Burial
11-14-88.................................................................Pine View...CrematoYY................................................................................
. .. ..................................... . .... .
®Cremation Address
Town of Queensbury, NY 12804
........ . .. .... ..
Z Date Place Removed
:Q.. ❑ Removal and/or Held
and/or Hold ..................:::::::...........:::::::::::......:..::............::........:...........:.:::.:::.:::,:::..............:.........::::.............:......:::::::.::::,:::::.::::::::::.::::::
Address
W Date Point of
[]Transportation by?; Shipment
Common Carrier .....................................................................................................................................................................
a ...::._...._........................................>.........__......... ._.......__...__...............__..........._..........._................_......._............._.............
Destination
............................ ::::::..................................................... ............. .::::::r::::.......................................... ..............
❑ Disinterment DateCemetery Address
...:::::::::::::::.:................................. ....
❑ ....... ................................................ .......... ........... ..................... ........ .......................
Date Address
Reinterment
Permit Issued to Registration Number
Name of Funeral Firm Regan & Denny Funeral Service, Inc. 02883
Address::::::.............................................................................................................................................................................................................................................................
40 Quaker Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition
osition or to Whom
::::::.......................................................................................................................................................
Remains are Shipped, If Other than Above
...... ..... ............................................................................................................................................................................. .
€f t;l
Address
0................................_..............._......_...._................_....................._.._........ ............................................................... ......................................................._..........
Permission Is hereby granted to dispose of the human r ains described above s Indicated.
Date Issued 1 -l y - �'b Registrar of Vital Statistics
(s' nature)
District Number .57 Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition —M — Place of Disposition 101(�V yl�F 721/1 /
(address)
>w.
N (section) (lot number) (grave number)
° g .b�i9�,b
� Name of Sexton o Person in C ar a of Premi s
"La.
(please print)
Signature Title
DOH-1555(9/86)p 1 of 2(formerly VS-61)