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McKinney, Keith NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit r, Name First Middle Last Sex 0.7'. Keith R McKinney Male Date of Death Age If Veteran of U.S. Armed Forces, June 26, 2016 60 War or Dates Place of Death Hospital, Institution or City, Town or Village Glens Falls Street Address Glens Falls Hospital lit Manner of Death I XI Natural Cause Accident I I Homicide Suicide Undetermined Pending 1Circumstances Investigation Medical Certifier Name Title tifr, Farkana Kamal Dr. Address rjr� 100 Park St.,Glens Falls,NY 12801 Death Certificate Filed District Number O 1 Register Number ;fj City, Town or Village it ❑Burial Date Cemetery or Crematory June 28, 2016 Pine View Crematorium ❑Entombment Address ©Cremation 51 Quaker Road, Queensbury,NY 12804 Date Place Removed Z I I Removal and/or Held and/or Address I. Hold p Date Point of N'I 1 Transportation Shipment p by Common Destination Carrier Disinterment Date Cemetery Address Reinterment Date Cemetery Address -:rd Permit Issued to Registration Number ' , Name of Funeral Home Regan Denny Stafford Funeral Home 01443 Address r ti 53 Quaker Road, Queensbury,NY 12804 j Name of Funeral Firm Making Disposition or to Whom 1°`j� Remains are Shipped, If Other than Above Address r4 Permission is hereby granted to dispose of the human remains described above as indicated.�p tzo :::j Date Issued Li 2ci J i T, Registrar of Vital Statistics L)C�� g �� .-A- `'if .' (signature a District Number S b 0/ Place 4, ca,v,sp_c k j ) S, cJ 7 of F I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: W Date of Disposition (o(jo'I)o Place of DispositionMa—,/ � twM.. 2 (address) W (1) W (section) (lot number) (grave number) oName of Sexton or Person in Charge o Premises ir"Atre" 2Z Sease print) W Signature Title Ci2iM102 (over) DOH-1555(02/2004)