Mattison, Walter -23 5-
NEW YORK STATE DEPARTMENT OF HtALTH`
Vital Records Section Burial - Transit Permit
Name First Middle " Last Sex
Walter O. Mattison Male
pHilli Date of Death 0 3/21 /2 01 7 Age 71 If Veteran of U.S. Armed Forces,
War or Dates
} Place of Death Hospital, Institution
City, g Street Address
r
Argyle o.582 West Rd.
TNAFn or Villa a
0 Manner of Death 0 Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending
W Circumstances Investigation
tu Medical Certifier Name Title
CA JoSe4N Mihincalu. iDr.
iiiiiii Address
S"Z Pet--IC s-t. &/en c-4//s-` Al)/ I75b1
Death Certificate Filed Argyle District Number 5750
Register Number
City, TOoaot or Village
❑Burial Date 03/22/201 7 Cemetery or Crematory Pine View Crematorium
in❑Entombment Address
iig(Cremation 21 Quaker Rd. Queensbury, NY 12804
Date Place Removed
g" ❑Removal and/or Held
`0 and/or Address
i=" Hold
Date Point of
i 0 Transportation Shipment
C by Common Destination
Carrier
❑Disinterment Date Cemetery Address
❑Reinterment Date Cemetery Address
Permit Issued to MB Kilmer FH RNibtr ion Number
Name of Funeral Home
Address 123 Main St. Argyle, NY 12809
Ci Name of Funeral Firm Making Disposition or to Whom
• Remains are Shipped, If Other than Above
;'; Address
1r
UI
I" Permission is hereby granted to dispose of the hum ains described a-bo e s indicated.
illE Date Issued Registrar of Vital Statistics ' 0 270 I U ,l---
(signature)
District Number 57,56 Place vi of- Cil L
, i j,
I certify that the remains of the decedent identified above were disp sed of in accordance with this permit on:
Z
UU Date of Disposition */Z7 117 Place of Disposition / a C1 t'briv-
(address)
Ili
U/
CC (section) 1 (lot number) (grave number)
Ct
CI Name of Sexton or Person in Charge of Premises / ra WI IIb"
z please pri
Signature ' Title C WL
(over)
DOH-1555 (02/2004)