Kinnarney, Frederick NEW YORK STATE DEPARTMENT OF HEALTH
•
Vital Records Section 1 Burial - Transit Permit
Name First Middle Last Sex
Frederick R. Kinnarney Male
Date of Death Age If Veteran of U.S. Armed Forces,
May 26,2013 87 War or Dates World War II
Place of Death Hospital, Institution or
Z: City, Town or Village Johnsburg Street Address White Water Manor, Apt. 4
pManner of Death X Natural Cause Accident I 1 Homicide Suicide Undetermined Pending
Circumstances Investigation
w Medical Certifier Name Title
Dr.Daniel Way
Address
HIIHN,Warrensburg,NY 12885
Death Certificate Filed District Number Register Number
City, Town or Village Johnsburg 5655 13
❑Burial Date Cemetery or Crematory
May 28,2013 Pine View Crematory
0 Entombment Address
❑x Cremation 21 Quaker Rd., Queensbury,NY 12804
Date Place Removed
Z
Removal and/or Held
and/or Address
r' Hold
to
0 Date Point of
u) 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 00035
Address
3809 Main Street,Warrensburg,NY 12885
Name of Funeral Firm Making Disposition or to Whom
i— Remains are Shipped, If Other than Above
2 Address
Permission is hereby granted to dispose of the human rem ins described e as indicated.
Date Issued 6 o20j,3 Registrar of Vital Statistics Lit/ CGc�`
/ (signature)
District Number 5655 Place Johnsburg
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
/
w Date of Disposition T31-13 Place of Disposition c o,0 r41"-i
(address)
0 (section) /_ / of nurfi ) J (grave number)
pName of Sexton .� P- • Char•e of Premises t d¢'�-
Z / efi_ (ple se print)
gs 7
Signature ,ram Title
I
(over)
DOH-1555 (02/2004)