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Erikhman, Boris Meyer 4* -it Llib NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Boris Meyer Erikhman Male Date of Death Age If Veteran of U.S.Armed Forces, 06/04/2023 62 Years War or Dates E,.. Place of Death Hospital,Institution or Z City,Town or Village Hebron Town Street Address 6268 State Route 22,Hebron Town,New York 12832 ILI p Manner of Death Natural Cause Accident 0 Homicide OSuicide FlUndetermined Pending W Circumstances Investigation W Medical Certifier Name Title CI Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Hebron District Number Register Number City,Town or Village 5760 8 ,,...M/W*... Date Cemetery,Crematory or Facility Name 06/07/2023 Pine View Crematorium Entombment Address Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or and/or Held F. Hold Address CD 0 0. Date Point of N Dransportation Shipment p by Common Carrier Destination Date Cemetery Address nDisinterment Date Cemetery Address ri Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above 5- Address CC ILl O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/07/2023 Registrar of Vital Statistics (Dorothy Worthington(ECectronicatry Signer) (signature) District Number 5760 Place Town Of Hebron I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition (t I$(13 Place of Disposition A<, k-. 2 (address) W Cl) (section) g (lot number) (grave number) QG Name of Sexton or Person in ChargePremises ' �"'' it Z (/T ease print) p III Signature /„..P Title !P`' i jDt DOH-1555(07/18)p 1 of 2 «- . . ) .a ..�r 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# NEW YORK STATE DEPARTMENT OF HEALTH / Burial _ Transit Permit Bureau of Vital Records Name First Middle Last Sex Boris Meyer Erikhman Male Date of Death Age If Veteran of U.S.Armed Forces, 06/04/2023 62 Years War or Dates F Place of Death Hospital,Institution or Z City,Town or Village Hebron Town Street Address 6268 State Route 22,Hebron Town,New York 12832 Manner of Death Undetermined Pending W Natural Cause nAccident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title Wesley Perry Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Town Of Hebron District Number Register Number City,Town or Village 5760 8 Burial Date Cemetery,Crematory or Facility Name 06/07/2023 Pine View Crematorium IllEntombment Address ©Cremation Queensbury Town,New York Donation ZniRemoval0 Li Date Place Removed and/or and/or Held N Hold Address 0 Date Point of U) Transportation p by Common Shipment Carrier Destination Date Cemetery Address Disinterment Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom 1 Remains are Shipped,If Other than Above Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 06/07/2023 Registrar of Vital Statistics 1Dorotlty Worthington kctronicat7 Send) (signature) District Number 5760 Place Town Of Hebron I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH Z Date of Disposition 1q/5"/23 Place of Disposition PrF"i' —) at 11 2 ( (address) W CC CC (section) (lot number) (grave number) Name of Sexton or Person in Ch ge of Premises (plea a print) W Signature l Title l�f`/Vt �'i DOH-1555(o7/1.8)p t of 2 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#