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Eichler, Roxane L.
„it- 25 NEWYORKSTATEDEPARTMENTOFHEALTH Burial - Transit Permit) Bureau of Vital.Records Name First Middle Last Sex Roxane L.Eichler Female t„ Date of Death Age If Veteran of U.S.Armed Forces, 03/07/2021 87 Years War or Dates i.: Place of Death Hospital,Institution or fJZ.1 City,Town or Village Johnsburg Town Street Address Elderwood at North Creek pManner of Death ©Natural Cause ID Accident ❑Homicide El Suicide ❑Undetermined ❑Pending V _ Circumstances Investigation ui Medical Certifier Name Title James Hindson MD Address 112 Ski Bowl Rd,Johnsburg Town,New York 12853 Death Certificate Filed District Number Register Number City,Town or Village North Creek 5655 9 ❑Burial Date Cemetery,Crematory or Facility Name 03/11/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation 6 ❑Removal Date Place Removed and/or and/or Held H Hold Address N 0 N ❑Transportation I Date Point of p by Common Shipment Carrier Destination ElDate Cemetery Address .r. ❑Reinterment Date Cemetery Address <; Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom i. Remains are Shipped,If Other than Above N Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/10/2021 Registrar of Vital Statistics Ngtfifeen C.Lorah(E(ectronica1tySigned) (signature) District Number 5655 Place North Creek, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: /i W Date of Disposition 3111121 Place of Disposition L�tS 2 (address) W CC N (section) (lot tuber/ (grave number) I� � L Name of Sexton or Person in Charge of Pre ises `�. v� Z (please pri t) W , Signature (.a-, Title 6/4740 DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 014627 Receipt 1 Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#