Sweenor, Robert NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
:r• ': Name First Middle Last Sex
Robert Sweenor Male
• Date of Death Age If Veteran of U.S. Armed Forces,
:f:: July 11, 2015 48 War or Dates
%:: Place of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
1Manner of Death Undetermined Pending
!xi Natural Cause I Accident Homicide Suicide Circumstances Investigation
Medical Certifier Name Title
Farkana Kamal Dr.
Address
100 Park St.,Glens Falls,NY 12801 i r umber
Death Certificate Filed District Number R R J�
: r City, Town or Village Glens Falls,NY 5601 �.11
❑Burial Date Cemetery or Crematory
July 13, 2015 Pine View Crematorium
❑Entombment Address
❑x Cremation Quaker Road, Queensbury, NY 12804
Date Place Removed
Z I I Removal and/or Held
C and/or Address
H Hold
cn
o Date Point of
NI I Transportation Shipment
p by Common Destination
Carrier
I I Disinterment
Date Cemetery Address
I Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
▪ Address
94 Saratoga Avenue, South Glens Falls, NY 12803
Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
Address
'g:; Permission is hereb granted to dispose of the human remains d cribed abtZve assiindic• ed.
Date Issued (�1 I ( Registrar of Vital Statistics jifTi.. ..." ` 47--('
(signature)
District Number J o ( Place Glens Falls,NY
~ I certify that the remains of the decedent identified above wer disposed of in accordance with this permit on:
W Date of Disposition 1ItKJ1c Place of Disposition 4;474,0..1 Cr '40.1
2 (address)
W
O (section) A (tot number)^ _ (grave number)
p Name of Sexton or Person in Charge of Premises
lease print)
W Difl-
Signature Az . Title rah*fiP
(over)
DOH-1555(02/2004)