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Bickford, Lawrence James
#1 310 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Lawrence James Bickford Male Date of Death Age If Veteran of U.S.Armed Forces, 03/28/2021 89 Years War or Dates 1_, Place of Death Hospital,Institution or Z City,Town or Village Albany Street Address Albany Medical Center Hospital W Manner of Death Undetermined Pending W © Natural Cause 0 Accident �Homicide ❑Suicide ✓ Circumstances Investigation W Medical Certifier Name Title Kristi Tempro MD Address 43 New Scotland Ave,Albany,New York 12208 Death Certificate Filed District Number Register Number City,Town or Village Albany 0101 0891 ❑Burial Date Cemetery,Crematory or Facility Name 03/30/2021 Pine View Crematory Entombment Address --' r�-..._,.^:r_ T- 1eer,abuijr' ❑Donation Removal Date Place Removed and/or and/or Held Hold Address N 0 d. Date Point of N ❑Transportation by Common Shipment Carrier Destination EI 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 H Remains are Shipped,If Other than Above 2 Address C W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/30/2021 Registrar of Vital Statistics Danielle S Gillespie(Electronically Signed) (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: Date of Disposition 3130114 Place of Disposition (address) W N (section) (lot number (grave number) $ number __ Name of Sexton or Person in Charge of Pre ises z (p!e e print) W Signature Title ` acm RV DOH-1555(07/18)pi of 2 Public Health Law Sec. 4145(2b) 014•S 7 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#