Hickey, Anna NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Vital Records Section
Name FirAsna VMiddle Last Sex
Hickey Female
Date ofJytfi6, 1997 Age 82 If Veteran of U.S. Armed Forces,
War or Dates
Place of Death Hospital, Institutio or
Saratoga Springs �aratoga Hospital
City, Town or Village Street Address
Manner of Death Natural Cause Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
Circumstances Investigation
Medical Certifier Nam&r. Susan Dorsey TitleDr.
Z.
Ad
q� yrtle Street Saratoga Springs, NY 12866
Death Certificate Filed District Number Register Numb �y
Saratoga Springs �S
City,Town or Village /
Date Cemetery or Crematory
❑Burial July 18, 1997 Pine View Crematory
AddrQeuaker Road
M Cremation Queensbury, NY
Date Place Removed
❑Removal and/or Held
0 and/or Address
a Hold
0 Date Point of
❑Transportation Shipment
by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to William J. Burke & Sons Funeral Home Re�02r6a�iOn Number
Name of.Funeral Home
€. Ad
ONSNorth Broadway, Saratoga Springs, NY 12866
s Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human reZ ainse;?ibedro a ted.
Date Issued i 7 p Registrar of Vital Statistics
(signature)
District Number 5_0
Place Saratoga Springs,New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
LU
Rafe of Disposition ;[ Place of Disposition
..2 (address)
UJ
S/J
f>E (section)/ (lot numnL
(grave number)
Name of Sext or Person in Charge of Premises�_,P:/ A�
(please print)
Signature Title
DOH-1555 (10/89) p. 1 of 2 VS-61