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Sweet, John Clyde .4 Z©3 NEWYORKSTATE DEPARTMENT OF HEALTH Burial-Transit Permit Bureau of Vital Records Name First Middle Last Sex John Clyde Sweet Male Date of Death Age If Veteran of U.S.Armed Forces, 02/28/2022 68 Years War or Dates H Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital 0 Manner of Death aNatural Cause Accident OHomicide Suicide Undetermined Pending yti Circumstances Investigation Medical Certifier Name Title G David Foote MD Address 340A Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed CKY omens Fats District Number Register Number ,Town or Ville Ge 5601 139 Burial Date Cemetery,Crematory or Facility Name 0 ddres022 Pine View Crematorium Entombment Address Cremation Oueensbury Town,New York Donation Removal Date Place Removed and/or and/or Held Hold Address 60 'd .Transportation Date Point of a, by Common Shipment Carrier Destination Date Cemetery Address ❑Disinterment ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom — Remains are Shipped,If Other than Above sAddress Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/04/2022 Registrar of Vital Statistics Megan Aroairr(°Eisi s (signature) District Number 5601 Place City Ol Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Il•-uiZ Date of Disposition .3 a pU -Zd2 L Place of Disposition Pin e-ui e. J C re 4, •' (address) w CCCC (section) (lot number) (rave number) 8 Name of Sexton or Person i harge of Premises % r_e "' 4-4-4 e__ Z (please print/ ,�j w Signature Title C /'4-r,.r_44 "l, i `r'"' DOH-1555(07/18)p 1 f 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#