Mattison, Peggy NEW YORK STATE DEPARTMENT OF HEALTH , �1C-
Vital Records Section t ) Burial - Transit Permit
Name First Middle Last Sex
Peggy Mattison Female
Date of Death Age If Veteran of U.S. Armed Forces,
October 23, 2017 62 War or Dates
P e of Death Hospital, Institution or
I: ity Town or Village Albany Street Address ST. PETER'S HOSPITAL
anner of Death R71xi Natural Cause ❑ Accident ❑ Homicide ❑ Suicide ❑ Undetermined ❑ Pending
t),; Circumstances Investigation
1114 Medical Certifier Name Title
CI Zothanmawii Khiangte,
Address
5 Palisades Drive, Suite 100 Albany, NY 12205
D--th Certificate Filed District Number Register Number
Town or Village /-1-( b 0.,n Li°ElBurial Date Cemetery or Crematory
October 25, 2017 Pine View Crematorium
❑Entombment Address
®Cremation Quaker Road Queensbury,NY 12804
Date Place Removed
- ❑ Removal and/or Held
0 and/or Address
Hold
t '
Date Point of
t13❑Transportation Shipment
Cl); by Common Destination
0 Carrier
❑ Disinterment Date Cemetery Address
Ell Reinterment 44-
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home, Inc. 00281
Address
Carleton Funeral Home, Inc. 68 Main St., P. O. Box 67 Hudson Falls, NY 12839
Name of Funeral Firm Making Disposition or to Whom
14; Remains are Shipped, If Other than Above
I... Address
W.
t1 , Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued ��! 2.5/Z v 1 '� Registrar of Vital Statistics D� �� .� y I, t e (C
(signature)
District Number bl 0 i Place ek of Albany
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
w Date of Disposition 10/25/2017 Place of Disposition Quaker Road Queensbury,NY 12804
2- (address)
CO
C (section) (lot number) (grave number)
O• Name of Sexton or Person in Charge of P mises irtaic ., el-AO
z / (pl ase print)
Signature 4l �-•&. Title Plirltel TV-
(over)
DOH-1555 (02/2004)