Burghard, Mildred y
/1 2s-
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Bu ial - Transit Permit
Name First Middle Sex
Mildred Burghard Female
Date of Death Age If Veteran of U.S. Armed Forces,
03 / 25 / 2017 77 WarN/A
1- Place of Death Hosp- , Institution or
WCity, Town or Village Saratoga Springs Str t Address Mary's Haven
II Manner of Death®Natural Cause 0 Accident ❑Homicide E Suicide — Undetermined 0 Pending
Lit —Circumstances Investigation
tu Medical Certifier Name Title
Q Edward M. Liebers
Address
3 Care Ln # 300, Saratoga Springs, NY 12866
Death Certificate Filed District Number Register er
City, Town or Village Saratoga Springs rq��, 1 `c ")
0Burial Date Cemetery or Crematory
03 / 27 / 2017 Pine View Crematory
‹]Entombment Address
Cremation Queensbury, Ny
"' Date Place Removed
Z❑Removal and/or Held
4 and/or Address
za
Hold
Date Point of
as Q Transportation Shipment
C by Common I Destination
Carrier
Q Disinterment Date Cemetery Address
Q Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care 1 00364
Address
402 Maple Ave. , Saratoga Sp. , NY 12866
Name of Funeral Firm Making Disposition or to Whom
• R• emains are Shipped, If Other than Above
2 Address
Z
ILI
P• ermission is h reby ranted to dispose of the human remains des ib abouo ' dicated
Date Issued • �•i 17 Registrar of Vital Statistics
(signature)
District Number Li,*co I Place Saratoga Springs , New York
C I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z
ILL Date of Disposition 3j1.9 JO Place of Disposition F„ �'V,L,r `..�,,,��-v;,,,, '
(address)
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fil
1L' (section) (lot number) (grave number)
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.0 Name of Sexton or Person ill Charge of Pre ises `^ry SL+14l14-
Zz. (pl se print) .
ta
Signature �� 44, Title fitani al,
9
(over)
DOH-1555 (02/2004)