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Strong, Randy Joseph (sto6 . ti6o y NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Randy Joseph Strong • Male Date of Death Age If Veteran of U.S.Armed Forces, 07/21/2023 57 Years War or Dates i_ Place of Death Hospital,Institution or Z City,Town or Village Queensbury Town Street Address 13 Pershing Road,Queensbury Town, New York 12804 UJ p Manner of Death 0 Natural Cause Accident 0 Homicide 0Suicide I—IUndetermined ❑Pending W ' ('Circumstances Investigation W Medical Certifier Name Title O Paul Filion MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 116 ▪Burial Date Cemetery,Crematory or Facility Name 07/27/2023 Pine View Crematory IllEntombment Address ©Cremation Queensbury Town,New York ▪Donation 0 Removal Date Place Removed and/or and/or Held 1- Hold Address CO 0 a Date Point of tJ) Transportation Shipment Q by Common Carrier Destination Date Cemetery Address Disinterment ❑Reinterment Date Cemetery Address 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 I— Remains are Shipped,If Other than Above a Address CC W 0" Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/26/2023 Registrar of Vital Statistics Caroline Hildegarde Barber(Electronically 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: Z4---- W Date of Disposition -7(Z1 1/3 Place of Disposition �,.,‘1%.� (address) W N (section) flot number) _ (grave number) CC 8 Name of Sexton or Person in Charge of Premises r's ks-- z (pleas int) W iZr-Signature Title ` rev DOH-1555(o7/t8)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#