Swinton, Kevin Wallace Sr. `rLF # ---/q
NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle last Sex
Kevin Wallace Swinton Sr. Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/04/2022 59 Years Waror Dates
H Place of Death Hospital,Institution or
ZCity,Town or Village Glens Falls Street Address 49 Montcalm Street,Glens Falls,New York 12801
Manner of Death El Natural Cause ❑Accident 0 Homicide DSuicide ❑Undetermined ❑Pending
W Circumstances Investigation
W Medical Certifier Name Title
G Scott Miller PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed city Of Glens Faits District Number Register Number
City,Town or Village 5601 508
HEntombmentBurial Date Cemetery,Crematory or Facility Name10/06/2022 Pine View Crematory
Address
Cremation Que3nsbusy Town,New York
Donation
gElRemoval Date Place Removed
and/or and/or Held
H F.) Hold Address
0�Transportation Date Point of
p by Common Shipment
Carrier Destination
Disinterment
Date Cemetery Address
Date Cemetery Address
0Reinterment
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
1— Remains are Shipped,If Otherthan Above
5 Address
cc
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/06/2022 Registrar of Vital Statistics Alvan groan(tE4cfrott Srgts4
/signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition 10 Ji. I27 Place of Disposition r.,
d s
W rl ��,..
N
(_ (section) I (lot number) �, (grave number)
NiName of Sexton or Person in Charge Premises ifi
Z (plee print)
W Signature Title ( i t'
DOH 1555(07/18)p 1 of 2
63O4
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on • , 20 =
Pine View Cemetery Representing the-fiineral home named on burial permit
Official Funeral Directors Reg.or License#