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NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Joyce Marie Mattison Female
Date of Death Age If Veteran of U1"*.S.A e Forces,
11/05/2022 89 Years War or Dates
F.. Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
11.1
p• Manner of Death ❑X Natural Cause Accident []Homicide [] []
Suicide Undetermined []Pending
' 'Circumstances I 'Investigation
W Medical Certifier Name Title
C Kelly Maley PA
Address
100 Park St,Glens Falls,New York 12801
Death Certificate Filed City Of Glens Falls District Number Register Number
City,Town or Village 5601 565
[]Burial Date Cemetery,Crematory or Facility Name
11/10/2022 Pine View Crematorium
Entombment Address
Cremation Queensbury Town,New York
Donation
ZO❑Removal Date Place Removed
and/or and/or Held
H Hold Address
U)
0
n, Date Point of
U)[]Transportation
Q by Common Shipment
Carrier Destination
O
Disinterment
Date Cemetery Address
[]Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carleton Funeral Home Inc 00281
Address
68 Main Street,P.O.Box 67,Hudson Falls,New York 12839
Name of Funeral Firm Making Disposition or to Whom
1.-. Remains are Shipped,If Other than Above _
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/09/2022 Registrar of Vital Statistics Alegan Min(ECectronicaCCySigned)
(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
Z Date of Disposition If 111 in Place of Disposition „t ,_v, ._
W
2 (address)
W
(/)
Q g (section) C�llot number) ���rave number)
g Name of Sexton or Person in Charge f Premises ^�
Z (please print)
w ii m►9i7
Signature Title
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b)
Receipt
Human remains of delivered on itt, ' �':' , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#