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McKenney, Robert NEW YORK STATE DEPARTMENT OF HEALTH Mil Vital Records Section Burial - Transit Permit Name First Middle Last Sex • Robert Stuart McKenney Male Date of Death Age If Veteran of U.S. Armed Forces, 11/24/2017 86 Years War or Dates Korean War Place of Death Hospital, Institution or City, Town or Village Queensbury Town Street Address Westmount Health Facility Manner of Death© Natural Cause El Accident El Homicide El Suicide ❑ Undetermined ❑Pending Circumstances Investigation Medical Certifier Name Title Roslyn Socolof MD Address "tee 42 Gurney Ln,Queensbury Town,New York 12804 - Death Certificate Filed District Number Register Number I City, Town or Village Queensbury 5657 148 74❑Burial Date Cemetery or Crematory 11/27/2017 Pine View Crematory t El Entombment Address ®Cremation Queensbury Town, New York Date Place Removed ❑Removal and/or Held and/or Address Hold Date Point of ❑Transportation Shipment by Common Destination Pv Carrier ❑Disinterment Date Cemetery Address ot❑kx Reinterment Date Cemetery Address kiii Permit Issued to Registration Number Name of Funeral Home Miller Funeral Home 01199 Address 61 6357 Nys Rte#30, Indian Lake, New York 12842 i, Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above ----e Address Permission is hereby granted to dispose of the human remains described above as indicated. • Date Issued 11/27/2017 Registrar of Vital Statistics Carohne If Barber 'Electronically Signed' (signature) VI District Number 5657 Place Queensbury, New York I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Date of Disposition ///23/n Place of Disposition EN,1L ( ( - t v (address) -- (section) /` (lot number) (grave number) Name of Sexton or Person in Charge of Pre •ses II S 1.-alrt !mil ( se print) �` Signature G' Title nwit2 (over) DOH-1555 (02/2004)