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Lee, Sandra Sydra NEW YORK STATE DEPARTMENT OF HEALTH �.N Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Sandra Sydra Lee Female Date of Death Age If Veteran of U.S.Armed Forces, 10/03/2023 85 Years War or Dates ZPlace of Death Hospital,Institution or City,Town or Village Albany Street Address St Peters Hospital p Manner of Death 0 Natural Cause ❑Accident El Homicide Suicide ElUndeterrnined n Pending W V Circumstances Investigation QW Medical Certifier Name Title Rebecca Keim MD Address 315 S Manning Blvd,Albany,New York 12208 Death Certificate Filed City Of Albany District Number Register Number ,Town or Village 0101 2335 Burial Date Cemetery,Crematory or Facility Name 10/06/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation ❑Removal Date ' Place Removed P and/or and/or Held CO Hold Address O d. Date Point of N❑Transportation p by Common Shipment Carrier Destination ODisinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Maynard D Baker Funeral Home 01130 Address 11 Lafayette St,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1... Remains are Shipped,If Other than Above 2 Address CC W O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/05/2023 Registrar of Vital Statistics ?Gerry Bartholomew(E(ectronica(Cy Signed) (signature/ District Number 0101 Place City Of Albany I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition 010,-7 Z 3 Place of Disposition (0 A)e jr e..J C pemk,�-}p�� 2 (address) W (I) III (section) (lot number/ (grave number) 8 Name of Sexton or Person in Charge of Premises l'17 �. li� Z (please print) W Signature 1�i 'fl �� Title C ePSti't DOH-1555(07/18)p 1 of 2 ta Public Health Law Sec. 4145(2b) " 1 Receipt 1 Human remains of delivered on , 20�,, +'r Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#