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Dutson, Matthew Allen (\Y) * a2O NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Matthew Allen Dutson Male Date of Death Age If Veteran of U.S.Armed Forces, 11/19/2023 52 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Mount Pleasant Town Street Address Westchester Medical Center W Manner of Death g ID El Natural Cause Accident Homicide Suicide Undetermined ❑Pendin W Circumstances Investigation t11• Medical Certifier Name Title O Dana Krinsky MD Address 100 Woods Road,Mount Pleasant Town,New York 10595 Death Certificate Filed Town Of Mount Pleasant District Number Register Number City,Town or Village 5957 859 Burial Date Cemetery,Crematory or Facilit" 11/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation OZ❑Removal Date Place Removed and/or and/or Held - Hold Address 0 Date Point of U)❑Transportation Shipment p by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address 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 1— Remains are Shipped,If Other than Above S Address CC W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/21/2023 Registrar of Vital Statistics EmiCy Costanza(EfectronicalTy Signed) (signature) District Number 5957 Place Town Of Mount Pleasant I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W /Date of Disposition / Z/-T�Zj Place of Disposition rJe V s&vJ e'�iNjq'r 2 (address) W CC N (section) /tot number) (grave number) gName of Sexton or Person in Charge f Pre ise J'i4�i�ln�bC` Z < (please print) W Signature y/ ) Title Oees t— DOH-1555(07/18)p 1 of 2 .`m Lt Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 , PineView Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#