Mattison, Carole e a
NEW YORK STATE DEPARTMENT OF HEALTH 7S
Vital Records Section ,. Burial - Transit Permit
.: Name First Middle Last Sex
Carole Ann Mattison Female
:•r Date of Death Age If Veteran of U.S. Armed Forces,
December 16, 2014 68 War or Dates
•'iPlace of Death Hospital, Institution or
City, Town or Village Glens Falls Street Address Glens Falls Hospital
Manner of Death X Natural Cause Accident Homicide Suicide Undetermined Pending
i Circumstances Investigation
Medical Certifier Name Title
gi William John Byrne Dr.
Address
r. 102 Park Street,Glens Falls,NY 12801
▪ Death Certificate Filed District Numbe5601 Register Number
.•: City, Town or Village Glens Falls Jai
.,❑Burial Date Cemetery or Crematory
December 18, 2014 Pine View Crematory
❑Entombment Address
❑X Cremation Quaker Road, Queensbury,NY 12804
Date j Place Removed
Z Removal and/or Held
and/or Address
H Hold
U)
O Date Point of
NI I Transportation Shipment
5 by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
r;: Permit Issued to Registration Number
Name of Funeral Home Regan & Denny Funeral Home 01444
Address
::'r 94 Saratoga Avenue, South Glens Falls,NY 12803
✓f; Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
^ Permission is hereby granted to dispose of the huma remains d scribed bove a- indict ted.
1
r : Date Issued / /k /'-/ Registrar of Vital Statistics .aL
ti: (signature)
District Number 5601 Place
Glens Falls
I certify that the remains of the decedent identified above w re disposed of in accordance with this permit on:
WDate of Disposition 11/19//q Place of Disposition „K c.� c,+..citdrNr..
W (address)
U)
O (section) d (tot number) c (grave number)
QName of Sexton or Perso in Charge of Premises . ;J sow*
Z f ( ease print)
W
-4 Signature ----.. Title 14("O +`t
(over)
DOH-1555(02/2004)