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Austin, Matthew James . . . I )03 NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Matthew James Austin Male Date of Death Age If Veteran of U.S.Armed Forces, 10/05/2020 36 Years War or Dates E• Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address 234 Maple Street Apt. 1, Glens Falls, New York 12801 p Manner of Death ID Natural Cause Accident Ei Homicide El Suicide El Undetermined ©Pending W V Circumstances Investigation QW Medical Certifier Name Title Timothy Murphy Coroner Address 52 HAVILAND AVE,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 460 ▪Burial Date Cemetery,Crematory or Facility Name Entombment 10/09/2020 Pine View Crematorium Address 0 Cremation Queensbury Town,New York ❑Donation g0 Removal Date Place Removed H and/or and/or Held N Hold Address 0 a Date Point of Cl) ❑Transportation a by Common Shipment 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 I— Remains are Shipped,If Other than Above a Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/08/2020 Registrar of Vital Statistics qWert.Andrew Curtis(ECectronica1TySigned) (signature) District Number 5601 Place Glens Falls, New York I certify that the remains of the decedent identified above were disposed of in accordance with this' on: ' I— Z Date of Disposition 101 t3 ITO Place of Disposition IIJ 2 (address) W U) CC (section) ((lot number) (grave number) SName of Sexton or Person in Charge of emises �,4i}t} iii Z &•ift, se pri Signature Title L f `cv a DOH-1555(07/18)p 1 of 2 r II Public Health Law Sec. 4145(2b) s 14 0 9 5 Receipt i Human remains of tI delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#