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Mattison, Charles Edward tt 1 I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Charles Edward Mattison Male Date of Death Age If Veteran of U.S.Armed Forces, 11/10/2020 62 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Moreau Town Street Address 521 Gansevoort Road, Moreau Town, New York 12828 • Manner of Death © Natural Cause Accident Homicide Suicide Undetermined Pending W Circumstances Investigation W Medical Certifier Name Title O Susan Hayes-Masa Coroner Address 40 McMaster Street,Ballston Spa,New York 12020 Death Certificate Filed District Number Register Number City,Town or Village Moreau 4562 50 ❑Burial Date Cemetery,Crematory or Facility Name 11/17/2020 Pine View Crematory ❑Entombment Address lCremation Queensbury Town,New York ❑Donation Removal Date Place Removed and/or and/or Held H N Hold Address 0 O- 1-1 Date Point of N ❑Transportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan&Denny Funeral Service 01444 Address 94 Saratoga Ave,S Glens Falls,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— 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 11/17/2020 Registrar of Vital Statistics Geeann Mc cabe(Etectronica1Ty Signed) (signature) District Number 4562 Place Moreau, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition It�IB�jp Place of Disposition ta.11�- 2 (address) W (/) (section) (lot number) (grave number) GName of Sexton or Person in Charge of Premises (plea feprint) bh* n W Signature Title r ��r( DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) - 114 209 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#