McKinney Sr, George NEW YORK STATE DEPARTM NT O H ti 63J.3
Vital Records Section Burial - Transit Permit
E Name First Middle Last Seth�? (:/�Tn
George R. McKinney, Sr.
;:gin; Date of Death Age If Veteran of U.S.Armed Forces,
10 / 07 / 2014 72 War or Dates
0 Place of Death Hospital, Institution or
=a City,Town or Village City of Schenectady Street Address Ellis Hospital
in-
el Manner of Death L. Natural Cause 0 Accident Homicide E]Suicide nUndetermined 71 Pending
US I—I Circumstances Investigation
tu Medical Certifier Name Title
Johnathan H. Sun D.O.
'. Address
%sa 427 Guy Park Ave Amsterdam, NY 12010
::: Death Certificate Filed District Number Register Ntbt,
} City,Town or Village
City of Schenectady 4601 `�
ill®Burial Date 10 ! 09/ 2014 Cemetery or Crematory
{ ; Pine View Crematory
-
' `.0 Entombment
.,.vr Address
r
.9 Cremation Queensbury, New York
_A: Date Place Removed
XI I-1 Removal and/or Held
16—land/or Address
Hold
Date Point of
i0 Transportation Shipment
by Common Destination
ik,t Carrier
s,: Date Cemetery Address
:':: u Disinterment
0
<. Renterment
Date Cemetery Address
1
.};~ Permit Issued to Registration Number
fi. : Name of Funeral Home Alexander-Baker Funeral Home 00037
E Address
gi 3809 Main Street, Warrensburg, NY 12885
Name of Funeral Firm Making Disposition or to Whom
EE..'..'. Remains are Shipped, If Other than Above
X Address
M
Permission is hereby granted to dispose of the human remai d scri d abo as i .' ated.
I°` Date Issued - 10/8/2014 Registrar of Vital Statistics .— 0
-Ai s`,:; (signature)
le District Number 4601 Place
gi City of Schenectady , New York
..
il I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
la Date of Disposition io/1 j/H Place of Disposition e L., C .e..—
l (address)
!3.
CC (section) /J (tot number) c� (grave number)
QName of Sexton or Person in Charge of Premises •. nr1 J�►t
Z (p! asp print) -
T. Signature t'L / Title CfLF-T Vt
(over)
DOH-1555 (02/2004)