Sweet, Lucas Jay NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Lucas Jay Sweet Male
Date of Death Age If Veteran of U.S.Armed Forces,
06/20/2023 2 Years War or Dates
H Place of Death Hospital,Institution or •
Z City,Town or Village Queensbury Town Street Address 3 Weeks Road,Queensbury Town,New York 12804
ILI
p Manner of Death n Natural Cause Accident ❑Homicide Suicide nUndetermined ri Pending
W Circumstances Investigation
C)
ILLI Medical Certifier Name Title
C Joanne Porter MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 91
Burial Date Cemetery,Crematory or Facility Name
06/28/2023 Pine View Cemetery
Entombment Address
[Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
f- Hold Address
N
0
n. Date Point of
N OTransportation Shipment
p by Common
Carrier Destination
Date Cemetery Address
IIIDisinterment
C 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
i_ 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 06/22/2023 Registrar of Vital Statistics Caroliine.7filr1egaree Barber(ECectronica(Cy Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
I—
Date of Disposition (o.@b.r3 Place of Disposition p) \ OUG�. � b Cu.tens cif Nt� l&Q/
2 (address)
! /`
LLI ERie 077A
cc (section/ (lot number) (grave number)
0D Name of Sexton or Person in Charge of Premises rll �. �4
Z (please print)
IU Title 4.....,1
Signature D �ry r h u�.'i
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 012986
Receipt
Human remains of delivered on , 20i ,
'tie View emetery Representing the funeral home named on arial permit
Official Funeral Directors Reg.or License#
Sweet
Owner
Joseph & Elizabeth Sweet
Address Plot
3 Weeks Rd. Robert Gardens Queensbury, NY 12804 Erie
Phone # Lot #
518-361 -2469 27A
Deed # Date
4393 6.26.23
Cost Foundation Y - N
$2100.00
Location
West-Road 40can 11.
,
North-Vacant
East-Jones
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: DATE:
SIGNATURE: DATE:
Record of Interments
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4 9
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SWEET
NAME km"F) Age:
Lucas Jay Sweet 2
LotOwner:Joseph & Elizabeth Sweet
Lot# Erie 27A Grave# 1
Case: Concrete
Died: 6.2 0.2 3 Interred: 6.2 8.2 3
Funeral Home: CarletonFH
Cemetery: Pine View