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Sweet Jr., Harry Sheldon 1 i 457) N EW YORK STATE DEPARTMENT OF H EALTH Bureau of Vital Records • Burial - Transit Permit Name First Middle Last Sex Harry Sheldon Sweet Jr. Male Date of Death Age If Veteran of U.S.Armed Forces, 07/10/2021 74 Years War or Dates 1965-1968 ZZ Place of Death Hospital,Institution or City,Town or Village South Glens Falls Village Street Address 96 Hudson Street,South Glens Falls Village,New York 12803 ILJ p Manner of Death © Natural Cause El Accident ❑Homicide ❑Suicide 0 Undetermined ❑Pending VCircumstances Investigation MI Medical Certifier Name Title a Joseph Mihindukulasuriya MD Address 20 Murray Street,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village South Glens Falls Village 4524 18 ❑Burial Date Cemetery,Crematory or Facility Name 07/14/2021 Pine View Crematory Entombment Address ElCremation .;,,.,Queensbury Town,New York EiDonatiofr ., , 0 ❑Removal i Place Removed I-- and/or and/or Held N Hold Address 0 EL (I) ❑Transportation Date Point of p by Common Shipment Carrier Destination Disinterment 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 +— Remains are Shipped,If Other than Above 2 Address C IW O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/14/2021 Registrar of Vital Statistics Joy Bartholomew(Electronically Signed) (signature) District Number 4524 Place South Glens Falls Village, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: tIW Date of Disposition 7��S Ili Place of Disposition "Rat �— ell—b---- 2 (address) W CC (section) (lot number){ (grave number) SName of Sexton or Person in Charge of Premise (pleaspriLnt/ 2 W Signature Title ( "�fir� DOH-1555(07/18)p 1 of 2 - r Public Health Law Sec. 4145(2b) 01 4"344 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#