Sweet, Larry Willard Sr. •(L rr-
NEW YORK STATE DEPARTMENT OF HEALTH '` - 'f Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Larry Willard Sweet Sr Male
Date of Death Age If Veteran of U.S.Armed Forces,
12/30/2022 63 Years War or Dates
l— Place of Death Hospital,Institution or
W City,Town or Village Glens Falls Street Address Glens Falls Hospital
p Manner of Death lill Natural Cause []Accident III Homicide 0Suicide Undetermined []Pending
W Circumstances ' 'Investigation
W Medical Certifier Name Title
G Mathew Varughese DO
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 662
Burial Date Cemetery,Crematory or Facility Name
01/03/2023 Pine View Crematory
IllEntombment Address
Cremation Queensbury Town,New York
lilDonation
Date Place Removed
52❑Removal and/or Held
and/or
N
Hold Address
0
Date Point of
toTransportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
Disinterment
Date Cemetery Address
ElReinterment
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
F— Remains are Shipped,If Other than Above
5 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/03/2023 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(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 I/3 7L Place of Disposition (address)
W
CC (section) A /lot number j� (grave number)
ovu
O Name of Sexton or Person in Charge of Premises /pt aseprint/
Z ZP
(ikmA( 2
W Signature Title
DOH-1555(07/18)p 1 of 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#