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Boecher, Robert Lawrence NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Robert Lawrence Boecher Male Date of Death Age If Veteran of U.S.Armed Forces, 12/05/2021 72 Years War or Dates Place of Death Hospital,Institution or IIJ City,Town or Village Queensbury Town Street Address Glens Falls Center for Rehabilitation and Nursing 0 Manner of Death ©Natural Cause 0 Accident 1=1 Homicide 0 Suicide 0 Undetermined D Pending IJJ Circumstances Investigation QW Medical Certifier Name Title Wendy Steinhacker PA Address 152 Sherman Ave,Queensbury Town,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Queensbury 5657 234 0 Burial Date Cemetery,Crematory or Facility Name 12/07/2021 Pine View Crematory 11 Entombment Address X❑Cremation Queensbury,New York ❑Donation ZO ❑Removal Date Place Removed - and/or and/or Held N Hold Address 0 U)❑Transportation Date Point of O by Common Shipment Carrier Destination Disinterment Date Cemetery Address ElReinterment 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 a, Address Q W IL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2021 Registrar of Vital Statistics Caroline JfiCriegarde Barber(ECectronicalty Signed) (signature) District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: II- Z Date of Disposition /,L_y 2_,i Place of Disposition Pine,, V:c (rrr44`.Ird'>` (address) W CC (section) (lot number) (grave number) ofSexton orPersoninCharge ofremses t.(n.ty Sr ),rr,S Z Name Premises 3 ease print) W Signature A... A>) Title C/tnP is s' DOH-1555(07/18)p 1 of 2 rp , 5419 p Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#