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Mattison, Glenn W NEW YORKSTATE DEPARTMENT OF HEALTH t Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Glenn W.Mattison Male Date of Death Age If Veteran of U.S.Armed Forces, 10/14/2023 77 Years War or Dates 1963-1965 Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital ILI W Manner of Death Z Natural Cause EAccident Homicide Suicide Undetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title a Kasandra Frasier 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 476 Burial Date Cemetery,Crematory or Facility Name ® 10/16/2023 Pineview Crematorium _Entombment Address ©Cremation Queensbury Town,New York Donation QRemoval Date Place Removed c and/or and/or Held Hold Address 0 tL Date Point of (I) Transportation 5 by Common Shipment Carrier Destination Disinterment Date Cemetery Address Reinterment 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 }. Remains are Shipped,If Other than Above .", Address :itr LLt (L Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/16/2023 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: E'- Z Date of Disposition JoJj,1Z3 Place of Disposition '�3,u ,E,�/ CAE A14r+___ X (address) W CC (section) n (lot numberl----..` (grave number) Name of Sexton or Person in Charge of Pr ises A 4\�yN+f'� z' )lease print) Signature Title DOH-1555(07/18)p 1 of 2 -- Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home namedifonburial/peit Official Funeral Directors Reg.or License#