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Getty, Randy Douglas 1403a NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Randy Douglas Getty Male Date of Death Age If Veteran of U.S.Armed Forces, 12/20/2023 65 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Kingsbury Town Street Address 3691 State Route 4, Kingsbury Town, New York 12839 p Manner of Death ZNatural Cause []Accident Homicide []Suicide FlUndetermined ❑Pending W Circumstances Investigation W• Medical Certifier Name Title G Darci Gaiotti-Grubbs MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Kingsbury District Number Register Number City,Town or Village 5762 18 ElBurial Date Cemetery,Crematory or Facility Name 12/22/2023 Pine View Crematorium []Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held - Hold Address 0 d Date Point of Cl) Transportation Shipment Q by Common Carrier Destination []Disinterment Date Cemetery Address []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 2 Address CC W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/21/2023 Registrar of Vital Statistics Cynthia cBardin(ECectronica1TySigned) /signature/ District Number 5762 Place Town Of Kingsbury I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: IH � W Date of Disposition /'ZZ-4z,3 Place of Disposition v' e 1,,ii (address) W CC N (section) (lot rnber) (grave number) O Name of Sexton or Person in Charge of Premis s; ��%r�0: L (please print) !' W Title Signature �Y G�y '� DOH-1555(07/18)p 1 of 2 1 • . ,...y,.7 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#