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Fuller, Matthew Jamaes NEW YORK STATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Matthew James Fuller Male Date of Death Age If Veteran of U.S.Armed Forces, 08/15/2023 61 Years War or Dates 1980-1983 Place of Death Hospital,Institution or Z City,Town or Village Hudson Falls Village Street Address 7 Main Street,Hudson Falls Village,New York 12828 p Manner of Death Z Natural Cause Accident Homicide ESuicide Undetermined riPending (W) Circumstances Investigation GMedical Certifier Name Title Robert Lemieux Coroner Address 415 Lower Main Street,Hudson Falls Village,New York 12839 Death Certificate Filed Village Of Hudson Falls District Number Register Number City,Town or Village 5726 24 Burial Date Cemetery,Crematory or Facility Name 08/17/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 0 Removal Date Place Removed and/or and/or Held H Hold Address 0 Date Point of N Transportation CI Common Shipment Carrier Destination 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 F_ Remains are Shipped,If Other than Above 2 Address CC W EL Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/16/2023 Registrar of Vital Statistics Cynthia Barn(ECectronicaCCySigned) (signature/ District Number 5726 Place Village Of Hudson Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition g Jzi I T3 Place of Disposition 2 (address) W N tr (section) / (lot number (grave number) 0 Name of Sexton or Person in Charge o r mises /� Z lease print) f W Signature Title t"�'Y+t� DOH-1555(07/18)p 1 of 2 •.11 1 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# -