McPhee, Rober NEW YORK STATE DEPARTMENT OF HEALTH Burial _ Transit Perm
Vital Records Sectiont
Name First Middle Last Sex
Robert P. McPhee Male
Date of Death Age If Veteran of U.S. Armed Forces,
August 31,2018 69 War or Dates
Place of Death Hospital, Institution or
City, Town or Village Warrensburg Street Address 213 State Route 28
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Manner of Death X Natural Cause Accident I I Homicide Suicide Undetermined Pending
#1 Circumstances Investigation
Medical Certifier Name Title
William Orluk
Address
Chester Health Center,Chestertown,NY 12817
Death Certificate Filed District Number Register Number
City, Town or Village Warrensburg 5660
❑Burial Date Cemetery or Crematory
Entombment September 5,2018 Pine View Crematory
Address
❑x Cremation 21 Quaker Rd., Queensbury, NY 12804
Date Place Removed
Z Removal and/or Held
9. and/or Address
t Hold
N
O Date Point of
ra I 'Transportation Shipment
a by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Alexander-Baker Funeral Home 00037
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
=. Remains are Shipped, If Other than Above
,2 Address
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Permission is h rep granted to dispose of the human remains dess bed above as indicated.
Date Issued q / Registrar of Vital Statistics l /0 w t�L t�j44
(signature)
District Number 5660 Place Warrensburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
iuDate of Disposition 11 S lig Place of Disposition 'F64- 4 rt�
2 (address)
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p0 (section) (I `number) (grave number)
Name of Sexton or Person in Charge of Premises r,JophVr_.*moll
Z lease print)
W Signature i( .4Title fl1Z+Pr1l-iak
(over)
DOH-1555 (02/2004)