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Cadwallader, Randall Lee I 77 6 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Randall Lee Cadwallader Male Date of Death Age If Veteran of U.S.Armed Forces, 12/02/2021 61 Years War or Dates 1980-1984 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital pManner of Death ©Natural Cause 0 Accident 0 Homicide El Suicide Undetermined El Pending W U Circumstances Investigation W Medical Certifier Name Title 0 Shahid Ahmed MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 568 IDBurial Date Cemetery,Crematory or Facility Name 12/04/2021 Pine View Crematorium ElEntombment Address ©Cremation Queensbury Hamlet,New York ElDonation 6 El Removal Date Place Removed and/or and/or Held F isHold Address 0 Date Point of CO Li Transportation Shipment b by Common Carrier Destination Ei Disinterment Date Cemetery Address 1:2Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Barton-Mcdermott Funeral Home Inc 00141 Address 9 Pine St,Chestertown,New York 12817 Name of Funeral Firm Making Disposition or to Whom E.. Remains are Shipped,If Other than Above 2 Address CC a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/03/2021 Registrar of Vital Statistics <p6ertAndrew Curtis(E(ectronicallySigned) (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 {Z/4 I Z( Place of Disposition ?tajo,... ( tor--- (adLIJ dress) LU LA Cr (section) number) (grave number) Name of Sexton or Person in Charge of Premises - 11(lot /.IL '�'viIt Z (plprint) MISignature C X tTitle (4MA ` DOH-1555(07/18)p i of 2 0 . 5404 Public Health Law Sec. 4145(2b) Receipt Human remains of I delivered on 1 a, , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# `.