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Mattison, Elsie Harriet sa NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Elsie Harriet Mattison Female Date of Death Age If Veteran of U.S.Armed Forces, 11/09/2021 91 Years War or Dates Place of Death Hospital,Institution or u City,Town or Village Argyle Town Street Address 1436 White Lane,Argyle Town,New York 12809 p Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending Circumstances Investigation W Medical Certifier Name Title CI Laurie Dennison NP Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Argyle 5750 69 ❑Burial I Date Cemetery,Crematory or Facility Name 11/09/2021 Pine View Crematory ❑Entombment Address X❑Cremation Queensbury Town,New York ❑Donation O ❑Removal Date Place Removed and/or and/or Held H N Hold Address 0 Date Point of t/) ❑Transportation by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079 Address 82 Broadway,Fort Edward, New York 12828 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped,If Other than Above 5 Address CC W Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/09/2021 Registrar of Vital Statistics Shelley Mckgrnon(ECectronicalTySigned) (signature) District Number 5750 Place Argyle, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: 4J1JL.... l• Date of Disposition (( ( (p Z+ Place of Disposition 2 (address) W CC (section) � (lot number) (grave number) 54, c,• Name of Sexton or Person in Charge of Pr ises (�1Y�� t4 Z (p ase print) ILI Signature Title L 4{"d. DOH-1555(07/18)p id 2 ♦ ham! 1 i^" wt .�[j •.:i Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#