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Malan, Matthew Joseph 40 # boo 1 NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Male Matthew Joseph Malan Date of Death Age If Veteran of U.S.Armed Forces, 12/07/2023 69 Years War or Dates E.. Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital LU p Manner of Death ❑X Natural Cause Accident n Homicide Suicide Undetermined Pending Circumstances Investigation 0 Title W Medical Certifier Name C3 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 570 Burial Date Cemetery,Crematory or Facility Name 12/13/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York Donation 8❑Removal Date Place Removed and/or and/or Held F- Hold Address N 0 Date Point of t)❑Transportation Shipment p by Common Carrier Destination . a O Disinterment Date Cemetery Address Date Cemetery Address Reinterment 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 5 Address CC W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 12/07/2023 Registrar of Vital Statistics Megan Wolin(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: IH Z Date of Disposition l'E Ifs I 3 Place of Disposition .:374r GCa) jived T'�jAJ`_ W (address) W CC CC (section) At__ ot number) , �� ,��� (grave number) 0Name of Sexton or Person in Charge of Premi s / � '"""vrZ / P (plrint) �p,�,,y� W (1 "Signature Title " Prai _ DOH-1555(07/18)p 1 of 2 I 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#