Mathewson, George Atterbury NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
George Atterbury Mathewson Esq Male
Date of Death Age If Veteran of U.S.Armed Forces,
01/04/2022 86 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
pManner of Death Natural Cause 0 Accident 0 Homicide 0 Suicide El Undetermined Pending
W Circumstances Investigation
W Medical Certifier Name Title
0 Lauren Dinsmore PA
Address
9 Carey Road,Queensbury Town,New York 12804
Death Certificate Filed District Number Register Number
City,Town or Village Glens Falls 5601 13
▪Burial Date Cemetery,Crematory or Facility Name
01/08/2022 Pineview Cemetery
❑Entombment Address
❑Cremation Queensbury,New York
O Donation
❑Removal Date Place Removed
and/or and/or Held
h Hold Address
0
a Date Point of
(/) ❑Transportation Shipment
Q by Common
Carrier Destination
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home McVeigh Funeral Home Inc 01155
Address
208 N Allen St,Albany,New York 12206
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
3 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 01/07/2022 Registrar of Vital Statistics Megan Wolin(Efectmnica1Ty Signed)
(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:
Z Date of Disposition ‘-B• as Place of Disposition at ,D LaE'�'JI�S Lary NV, 1a��
2 (address)
ERie '7 F
/section) (lot number) (grave number)
S Name of Sexton or Person in Charge of Premises Qnn+ �Uee
r (please print)
al SignatureAR_Aic, �' ��v Title S t 1 n den
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
012897
Receipt
Human remains of delivered on , 20
fine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License# —
MATHEWSON
NAME George Mathewson Age: 86
Lot Owner: George & Ann Mathewson
Lot# Erie 7F Grave# 1
Case: Concrete
Died: 1 .4.2 2 Interred: 1 .8.2 2
Funeral Home: McVeigh Funeral Home Inc, .
Cemetery: Pine View