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Sweet, Kathleen NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex Kathleen Sweet Female Date of Death Age If Veteran of U.S. Armed Forces, May 20, 2018 58 War or Dates IPlace of Death Hospital, Institution or City, Town or Village Queensbury Street Address 39 Mallory Ave Manner of Death Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ri 1--I Pending CircumstancesInvestigation W Medical Certifier Name Title a Andrew Garner, MD Dr. Address 8 Harrison Ave. Glens Falls, NY 12801 Death Certificate Filed Di �u„mbe�r Register Number City, Town or Village Queensbury ❑Burial Date Cemetery or Crematory May 25, 2018 Pine View Crematory ❑Entombment Address ©Cremation Quaker Road Queensbury,NY 12804 Date Place Removed ❑ Removal and/or Held and/or Address _ Hold 0 Date Point of i ❑Transportation Shipment by Common Destination rf Carrier Date Cemetery Address ❑ Disinterment Date Cemetery Address ❑ Reinterment Permit Issued to Registration Number Name of Funeral Home M.B. Kilmer Funeral Home-SGF 01078 Address 136 Main Street, South Glens Falls NY 12803 Name of Funeral Firm Making Disposition or to Whom aRemains are Shipped, If Other than Above Address 11A. Permission is hereby granted to dispose of the human insn described �bove`as indicated. Date Issued j a -lc)()1% Registrar of Vital Statistics 1� � ( (L,�,-�. -_, L (signature) District NumbC.6 c fl Place 1 O � ©-` ' 1.1/4_0_. A,,. I certify that the remains of the decedent identified above were disposed of in a cordance ith this permit on: w Date of Disposition 05/25/2018 Place of Disposition Quaker Road Queensbury,NY 12804 (address) ILI Lir (section) of number) (grave number) Name of Sexton or Person in Charg of Premises r.f Ji,,.rW,- ,' (please print) Signature Title rittPdtilii, (over) DOH-1555 (02/2004)