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Boecher, Walter NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records ; Name First Middle Last Sex Vil Walter Boecher Male Date of Death Age If Veteran of U.S.Armed Forces, `; 05/21/2021 99Years War or Dates Marines ▪ Place of Death Hospital,Institution or • City,Town or Village Johnsburg Town Street Address Elderwood at North Creek W Manner of Death Undetermined ❑Pending LIU O ©Natural Cause �Accident �Homicide �Suicide Circumstances Investigation Medical Certifier Name Title O Michael Miles 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 18 O Burial Date Cemetery,Crematory or Facility Name 05/24/2021 Pine View Crematory ❑Entombment Address lCremation Queensbury,New York ❑Donation oZRemoval Date Place Removed and/or and/or Held Hold Address tn 2 Date Point of en❑Transportation Shipment D by Common Carrier Destination Date Cemetery Address Disinterment • ❑Reinterment Date Cemetery Address • Permit Issued to Registration Number Name of Funeral Home Singleton Sullivan Potter Funeral Home 01596 Address 407 Bay Rd,Queensbury,New York 12804 • Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above Address 0. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 05/21/2021 Registrar of Vital Statistics Kptkteen C.Lorah(E(ectronica((y Signed) (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: Date of Disposition � �25 'Z02/ Place of Disposition ! /�P.‘.l !�i�rr ��� "`"��"/-'A Ili (address) CU IIE (section/ (lot number) (grave number) 8 Name of Sexton or Pers Charge of Premises tn./:CC.✓1 6svf.�e�`(Ii Z (please print) W Signature Title L/- +-c,h y OF r-c DOH-1555(07/18)p 1 o Public Health Law Sec. 4145(2b) 1 4 8 0 9 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#