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Matthewes, Eileen M SY/ NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Eileen M.Matthews Female Date of Death Age If Veteran of U.S.Ar es, - 09/24/2021 67 Years War or Dates ^ Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital p Manner of Death ©Natural Cause ❑Accident El Homicide El Suicide 1=1 Undetermined El Pending W Circumstances Investigation W Medical Certifier Name Title O Scott Biasetti MD Address = 100 Park St,Glens Falls,New York 12801 Death Certificate Filed District Number ' Register Number City,Town or Village Glens Falls 5601 418 ❑Burial Date Cemetery,Crematory or Facility Name 10/06/2021 Pine View Crematory ❑Entombment Address ElCremation Queensbury Town,New York ❑Donation Removal Date Place Removed IS I=1and/or and/or Held U) Hold Address 0 Date Point of (/) L j Transportation Shipment p by Common Carrier D4estination ❑Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 Address 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom F.. Remains are Shipped,If Other than Above 2 Address C W o Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 09/27/2021 Registrar of Vital Statistics `N96ert Andrew Curtis(EfectronicaffySigned) (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 permit on: / W' Date of Disposition 10���� Place of Disposition /,,,�� L P /addFes� �_ 2 W CCCC (section) ( 1114.ost� number) (grave number) 0 Name of Sexton or Person in Charge Premises `t'r+'if Z I (pie e print) W vie Signature Title ` �"404' � DOH-1555(07/18)p i of 2 Public Health Law Sec. 4145(2b) E.) 1• _ Ft90 Receipt 1 1 Human remains of /1 delivered on 1 , 20 1 ,' Pine View Cemetery Representing the funeral home named on hurinl,pprmit Official Funeral Directors Reg.or License#