Mattoon, Margaret F ,.. , lEit A V s-3
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records N.
Name First Middle Last Sex
Margaret F Mattoon j Female
Date of Death Age If Veteran of U.S.Armed Forces,
06/01/2022 86 Years War or Dates
F— Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
ILJ
p Manner of Death El Natural Cause Accident El Homicide []Suicide []Undetermined 17 Pending
IIJ
0 "Circumstances Investigation
W Medical Certifier Name Title
0 Anne Evans DO
Address
3 Irongate Center,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 299
EdBurial Date Cemetery,Crefnatory or Facility Name
06/03/2022 Pineview Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
- and/or and/or Held
1—- Hold Address
N
0
O. Date Point of
N❑Transportation Shipment
p by Common
Carrier Destination
Disinterment
Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Densmore Funeral Home Inc 00448
Address
7 Sherman Ave,Corinth,New York 12822
Name of Funeral Firm Making Disposition or to Whom
If— Remains are Shipped,If Other than Above
a Address
IE
W
II. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 06/02/2022 Registrar of Vital Statistics Megan Nolin(Electronically Signed)
(signature)
District Number 5601 Place City Of Glens Falls
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H (� A___Z Date of Disposition (3( Z? Place of Disposition /„Q
W address)
W
Cl)CC (section) Jlot number) (grave number)
I4
G Name of Sexton or Person in Charge of Premises �,1 �
1 p ase print)
z rp) 4. -
W Signature Title `"
DOH-1555(018)p t of 2
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#