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Mattison, Harold A
it I NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Harold A.Mattison Male Date of Death Age If Veteran of U.S.Armed Forces, 03/14/2023 71 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Saratoga Springs Street Address Saratoga Hospital • Manner of Death ❑X Natural Cause Accident []Homicide []Suicide Undetermined ❑Pending W C.) Circumstances Investigation ▪ Medical Certifier Name Title CI Qiong Wang MD Address 211 Church St,Saratoga Springs,New York 12866 Death Certificate Filed City Of Saratoga Springs District Number Register Number City,Town or Village 4501 173 []Burial Date Cemetery,Crematory or Facility Name 03/17/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation Z Removal Date Place Removed and/or and/or Held H N Hold Address 0 0- Date Point of tAITransportation p by Common Shipment Carrier Destination oDisinterment Date Cemetery Address Date Cemetery Address C Reinterment Permit Issued to Registration Number Name of Funeral Home M B Kilmer Funeral Home-South Glens Falls 01078 Address 136 Main St,S Glens Falls,New York 12803 Name of Funeral Firm Making Disposition or to Whom �.. Remains are Shipped,If Other than Above g Address Q W n' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/16/2023 Registrar of Vital Statistics Di!!an Moran(Ekctronicall:y Signer (signature) District Number 4501 Place City Of Saratoga Springs I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition 3-/f-ZoZ3 Place of Disposition ( /JO , rLe 2 (address) W CC to (section) (lot nu ber) (grave number) Name of Sexton or Person in Charge Premi )f1 y/T/O^J J ( Cr(1t-r O (p ease print) W Signature Title DOH-1555(07/18)p t of 2 31F 03 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# - '