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Mattison, Carol J
4 Ng (.1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Carol J.Mattison Female Date of Death Age If Veteran of U.S.Armed Forces, 08/10/2023 75 Years War or Dates Place of Death Hospital,Institution or W City,Town or Village Glens Falls Street Address Glens Falls Hospital Manner of Death ❑X Natural Cause Accident Homicide Suicide Undetermined 17 Pending ILI Circumstances Investigation E Medical Certifier Name Title Gamal Khalifa MD 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 378 Burial Date Cemetery,Crematory or Facility Name 08/11/2023 Pineview Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation ElRemoval Date Place Removed and/or and/or Held F- Hold Address ❑Transportation Date Point of ES by Common Shipment Carrier Destination Disinterment Date Cemetery Address Re interment 1 Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Mason Funeral Home 01117 Address 18 George St Po Box 277,Fort Ann,New York 12827-0277 Name of Funeral Firm Making Disposition or to Whom E... Remains are Shipped,If Other than Above ,"' Address 1C #Lt 0., Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/11/2023 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: Date of Disposition , --/2-?02_3Place of Disposition 21 h Ui`f,,,,i G/zrn 4 y a (address) IW CO (section) (lot nu er) (grave number) - LL 1/`0 vt 6,,le.t.,i, Name of Sexton or Person i haarr a of Premises (please print) 41 Signature 1 64�— Title L"'��"i` " a 9t---� '; y / DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) "a 03 Receipt s Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named rgn �lritLpe/►nit Official Funeral Directors Reg. or License# , - /