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Woodard, Sandra Ellen
1 � NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra Eileen Woodard Female Date of Death Age If Veteran of U.S.Armed Forces, 12/28/2019 79 Years War or Dates ZPlace of Death Hospital,Institution or W City,Town or Village Albany Street Address Albany Medical Center Hospital p Mannerof Death © Natural Cause Accident Homicide Suicide Undetermined Pending VCircumstances Investigation Q Medical Certifier Name Title Tara Fitzgerald NP Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 2824 FIBurial Date Cemetery,Crematory or Facility Name 12/30/2019 Pine View Crematory Entombment Address RI Cremation Queensbury Town,New York 0 Donation 0 Removal Date Place Removed and/or and/or Held ~ Hold Address N CL O (A EJ Transportation Date Point of p by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward,New York 12828 Name of Funeral Firm Making Disposition or to Whom �- Remains are Shipped,If Other than Above Address W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/30/2019 Registrarof Vital Statistics DanieCCeS GifleVie('6CectronicalTySigned) (signature/ District Number 0101 Place Albany, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: f- W Date of Disposition %h--3o-i jj Place of Disposition t,^ ,f. (address) W /section) (/ot number) (grave number) QName of Sexton or Perso�inarge of Premises y 'rcs Z (please print) W Signature Title DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) ' -� -3 Receipt Human remains of ` delivered on F : , 20 ine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#