McKee, Andrea r 4 3(a3
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
': Name First Middle Last Sex
Andrea M. McKee Female _
Date of Death Age If Veteran of U.S. Armed Forces,
May 2, 2018 63 War or Dates
Place of Death Hospital, Institution or
Z' City, Town or Village Johnsburg Street Address 464 Hudson St.
0 Manner of Death Undetermined Pending
Natural Cause I I Accident � I Homicide Suicide
itil Circumstances Investigation
Medical Certifier Name Title
Darci Ann Gaiotti-Grubbs MD
Address
102 Park St.,Glens Falls,NY 12801
Death Certificate Filed District Number Register umber
City, Town or Village Johnsburg 5655 s 1
❑Burial Date Cemetery or Crematory
May 3,2018 Pine View Crematory
❑Entombment Address
❑X Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z Removal and/or Held
and/or Address
H Hold
u)
O Date Point of
gj I I Transportation Shipment
p 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
' i
'rL
Permission is hereby granted to dispose of the human remains es ribed above as indicated.
Date Issued 05-03-18 Registrar of Vital Statistics i �1, ,•r/, , .1j1/-
(signature)
District Number 5655 Place Johnsburg,NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
W Date of Disposition S'l1 lig Place of Disposition eltiL. i rq,,"-
W (address)
CO
0 O (section) (lot number) (grave number)
p Name of Sexton or Person in Charge of Premises Ihr -alt
Z ( ease print)
W
Signature Title At—
(over)
DOH-1555 (02/2004)