Sweet Jr., Randy Earl NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Randy Earl Sweet Jr Male
Date of Death Age If Veteran of U.S.Armed Forces,
02/04/2021 41 Years War or Dates
Place of Death Hospital,Institution or
WCity,Town or Village Moreau Town Street Address 232 Reservoir Road,Moreau Town,New York 12828
p Manner of Death Natural Cause Accident 0 Homicide Suicide Undetermined Pending
C.) Circumstances Investigation
WO MedicCertifier Name Title
Donald Merrihew MD
Address
319 Bay Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Moreau 4562 10
Burial Date Cemetery,Crematory or Facility Name
02/09/2021 Pine View Crematory
Entombment Add ss
oit
0 Cremation Queensury Town,New York
Ei Donation
ZO Removal Date Place Removed
and/or and/or Held
N Hold Address
0
d Date Point of
Cl) Li Transportation
by Common Shipment
Carrier Destination
ElDisinterment Date Cemetery Address
Reinterment Date Cemetery Address
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
t— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/05/2021 Registrar of Vital Statistics Leeann caoe(&(ectronicaf SSned)
(signature)
District Number 4562 Place Moreau, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
~ �L /✓T _`Z Date of Disposition 7/II I1� Place of Disposition �
2 (address)
Ui
CC CC (section) (lot tuber) (grave number)
0 Name of Sexton or Person in Charge of Premi x 1) l t7
(lease prin
W Signature Title '^'"'' '<
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01. 4 '
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#