Eckhardt, Robert Lawrence NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Robert Lawrence Eckhardt Male
Date of Death Age If Veteran of U.S.Armed Forces,
09/17/2022 82 Years War or Dates
F Place of Death Hospital,Institution or
WCity,Town or Village Argyle Town Street Address Washington Center For Rehabilitation And Healthcare
p Manner of Death a Natural Cause Accident Homicide OSuicide nUndetermined ❑Pending
W Circumstances Investigation
U
W Medical Certifier Name Title
O Leah Terry NP
Address
4573 4573 NY-40,Argyle Town,New York 12809
Death Certificate Filed Town Of Argyle District Number Register Number
City,Town or Village 5750 53
Burial Date Cemetery,Crematory or Facility Name
09/21/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
IIIDonation
6❑Removal Date Place Removed
and/or and/or Held
HN Hold Address
0
a_ Date Point of
V) Transportation
p by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
0 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
1— Remains are Shipped,If Other than Above
2 Address
Q
W
0. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 09/21/2022 Registrar of Vital Statistics She((ey Mckernon(E(ectronica(fySigned)
(signature) ,
District Number 5750 Place Town Of Argyle
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I— �
W Date of Disposition q,7tJ rvzz Place of Disposition / ' up �Ae,� t�rBrT9 ,`
2 (address)
W
U)
CC (section) /lot n tuber) (grave numb(
0 Name of Sexton or Person in Char e of Premise e� nie.,b Zi/C1C�d
z �
y (please print)
W Signature !(/tsboi Title Orf5-4i,`t r
DOH-1555(07/18)p 1 of 2
"p 64
Public Health Law Sec. 4145(2b)
Receipt
Human remains of q delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#