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Matteson, Kathleen M
NEW YORK STATE DEPARTMENT OF HEALTH ` Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Kathleen M.Matteson Female Date of Death Age If Veteran of U.S.Armed Forces, 12/12/2023 75 Years War or Dates �. Place of Death Hospital,Institution or Z City,Town or Village Granville Town Street Address 7187 State Route 149,Granville Town, New York 12832 Manner of Death Undetermined Pending W El Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title O Aqeel Gillani ,'AD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed Town Of Granville District Number Register' . City,Town or Village 5756 Burial Date Cemetery,Crematory or Facility Name 12/15/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation goRemoval Date Place Removed and/or and/or Held pN Hold Address 0 Q. Date Point of Cl)n Transportation Shipment Q by Common Carrier Destination o Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address 53 Quaker Rd,Queensbury,New York 12804 Name of Funeral Firm Making Disposition or to Whom 1— Remains are Shipped,If Other than Above a Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/14/2023 Registrar of Vital Statistics Jenny Girufa M Martel(e(E(ectronicaC(y Signed) (signature) District Number 5756 Place Town Of Granville I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition /2/l---(0Z 3 Place of Disposition i46v,,) (. to-zeUJ c� ti UJ (addres W CC N (section), (lit number) (grave number) GName of Sexton or Person in Charge remi s �,4VP%%)) Z (please print) W Signature �� Title O in s g I t >G �� 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 named on burial permit Official Funeral Directors Reg.or License#