Sicard, Mary NEW YORKK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
MARY COLLYER SICARD FEMALE
Date of Death Age If Veteran of U.S.Armed Forces,
I 04/28/2014 92
War or Dates
Place of Death Hospital, Institution
City ,Town or Village City of Albany or Street Address ALBANY MEDICAL CENTER
Manner of Death Natural Undetermined Pending
®“ki Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Circumstances ❑ Investigationa. Medical Certifier Name Title
MATTHEW PEFRIE MD
Address
43 NEW SCOTLAND AVE., ALBANY NY 12208
n Death Certificate Filed District Number Register Number
• City,Town or Village City of Albany 101 831
Date Cemetery or Crematory
® Burial 05/03/2014 PINE VIEW CEMETERY
❑ Entombment Address
❑Cremation QUEENSBURY, NY
Date Place Removed
Z Removal and/or Held
2 0 and/or Address
Hold
CO
Date Point of
0-; Transportation Shipment
07 ❑ By Common Destination
C Carrier
❑ Disinterment Date Cemetery Address
Date Cemetery Address
❑ Reinterment
' Permit Issued To Registration Number
• Name of Funeral Home REGAN DENNY STAFFORD F.H. 01443
Address
53 QUAKER RD., QUEENSBURY NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
4At e
Address
Permission is hereby granted to dispose of the human remains desc " ed above as i i ated.
f/ /Date 04/29/2014 & R
Registrar of Vital Statistics
Issued
(signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
li Date of Disposition 5/3/201 4 Place of Disposition Pine View Cemetery
LU (address)
ui= Seneca 33 A 6
co
(section) (lot number) (grave number)
0
6ZL1 Name of Sexton or Person in Charge of Premises Connie L. Goedert
(please print)
Superintendent
Signature,a 1-c" `I -1+'/ Title
F
(over)
DOH-1555(02/2004)
SICARD
Lot No. 33 A
(dress 11 George St. Lake George NY 12845 Section No.
Nner Mary C. Sicard Plot Seneca
ite 11/1/01
Approx. 200 Superficial ft.
cation Bounded on North by Woods, South by Vacant, East by Path, West by Path.
rner Posts
marks -I c) 2 - Ccy b 3
ed No. (and changes) 3146
yment Record Paid in Full 11/1/01 ($2,400.00)
cord of Interments
Charles Sicard 7/19/03 L-
Cevr9e Uui S �e�a u 5 a� � ��a� a�r
x x /9-
f � t
X i
�, 5/3/2014 /#
I ► 3
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m No. 01
NAME SICARD, MARY COLLYER
Age: 92
B Natural
Cause:
Lot pw r; Mary C. Sicard
Lot M A Seneca
Grave # 6
Case # Concrete
Died: 4/28/2014
interred: 5/3/201 4
Undertaker: Regan, Denny & Stafford