Eckhardt, Sonya D IL(NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Sonya D.Eckhardt Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/06/2022 78 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Queensbury Town Street Address 212 5th Street,Queensbury Town,New York 12804
pManner of Death ❑X Natural Cause ❑Accident Ei Homicide OSuicide Undetermined riPending
W Circumstances Investigation
W Medical Certifier Name Title
0 Mary Stein NP
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 92
ElBurial Date Cemetery,Crematory or Facility Name
06/08/2022 Pine View Crematory
Entombment Address
Cremation Queensbury,New York
Donation
O❑Removal Date Place Removed
- and/or and/or Held
F- Hold Address
N
0
O. Date Point of
(p❑Transportation Shipment
5 by Common
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
1— Remains are Shipped,If Other than Above
a Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/08/2022 Registrar of Vital Statistics Caroline Jfififeganfe Barber(ECectronica(fy Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
W Date of Disposition �/$1 it Place of Disposition t"�•ki(�
2 (address)
W
Nac (section) (lot number) (`" (grave number)
gName of Sexton or Person in Charge of Premises LI IL- µ it
Zzef ( ease print)
W Title �t 'Mw;i�(�
Signature
DOH-1555(07/18)p id 2
` , 11, 4. x
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on , , 2e)
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#