Sweet, Robert NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
,; Name First Middle ' Last Sex
• Robert John Sweet Male
Date of Death Age If Veteran of U.S. Armed Forces,
10/16/2018 65 Years War or Dates
Place of Death Hospital, Institution or ,
3` City, Town or Village Glens Falls Street Address Glens Falls Hospital
a Manner of Death X Natural Cause Ei Accident 0 Homicide Suicide riUndetermined El Pending
f Circumstances Investigation
tit Medical Certifier Name Title
d Nawed Siddiqui MD
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed District Number Register Number
City, Town or Village Glens Falls 5601 489
Burial Date Cemetery or Crematory
10/18/2018 Pine View Crematory
d❑Entombment Address
®Cremation Queensbury Town, New York
VW Date Place Removed
❑Removal and/or Held
`Z and/or Address
Hold
Date Point of
0 Transportation Shipment
by Common Destination
Carrier
Disinterment
Date Cemetery Address
Q Renterment Date Cemetery Address
r Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078
• Address
136 Main St,S Glens Falls,New York 12803
Name of Funeral Firm Making Disposition or to Whom
ft Remains are Shipped, If Other than Above
a Address
Permission is hereby granted to dispose of the human remains described above as indicated.
y" Date Issued 10/18/2018 Registrar of Vital Statistics Robert Curtis(E(ectronica1TySigned)
(signature)
-; District Number 5601 Place Glens Falls, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition i0 (Z3,Ig Place of Disposition nlf tNr40P
(address)
41
(section) (lot number) c (grave number)
• Name of Sexton or Person in Charge of Premises (r't° r ~'e"^it
(ple a print)
Signature % Title NM
(over)
DOH-1555 (02/2004)