Lyford, Sandra UL/CJ4/LU1tj 14:C1b 15184895632 I TEBBUTT FREDERICK PAGE 01
NEW YORK STATE DEPARTMENT OF HEALTH # /13
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Sandra • Ann Lyford F
?': Date of Death Age ' If Veteran of U.S. Armed Forces,
; 02/01/2018 70 War or Dates N/A
Place of Death + Hospital, Institution or
211 City,Town or Village City of Albany Street Address Albany Medical Center Hospital
iiManner of Death 0 Natural Cause [J Accident D Homicide n Suicide Q Undetermined n Pending
Circumstances Investigation
Medical Certifier Name Title
Faris Al-Faris MD
.... Address
43 New Scotland Ave.,AlbanyzNY 12208
: Death Certificate Filed 1 District Number Register Number
City, Town or Village Albany 101
❑Burial Date Cemetery or Crematory
Entombment ANtest118 Fine View Crematorium
0 Cremation Queensbury,NY
Date Place Removed
❑Removal
and/or _�. and/or Held
Hold Address
aa.r Date - Point of -
.
D.Q Transportation Shipment
d by Common Destination
Carrier
Disinterment Date Cemetery Address
❑Reinterment
Date Cemetery Address
Permit Issued to Registration Number
c. Name of Funeral Home Regan Denny Stafford Funeral Rome 01443
Address
:.. . 53 Quaker Rd.,Qneensbury,NY 12804 Name of Funeral Firm Making Disposition or to Whom
t^ Remains are Shipped, If Other than Above
Address
IC Air
Permission is hereby granted to dispose of the human remai . erlbe as indicated.
Date Issued 02/04/2018 Registrar of Vital Statistics ,ram __
(signature)
District Number Place
Albany Police Department,Al.{ ny,NY
I certify that the remains of the decedent identified above were disposed of in accordancewith this permit on:
al Date of Disposition 2/1 It$ Place of Disposition . 11.t\.,, � f or....
(address) •
W
� ( ) /i..(lot numbed � (grave number) .
ti
ea Name of Sexton or Person in Charge of Premises F{�xs "r+�
Z (p ase Pint)
Signature h ,'(f Title (inA?(1"r .
(over)
nr7W-ir;Rc rnannren