McKinney, Philip NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Philip K. McKinney Male
Date of Death Age If Veteran of U.S. Armed Forces,
April 3,2012 93 War or Dates World War II And Korea
Place of Death Hospital, Institution or
Z City, Town or Village North Elba Street Address 346 Averyville Lane
Wp Manner of beath X Natural Cause Accident Homicide Suicide Undetermined Pending
W _ Circumstances Investigation
Lu Medical Certifier Name Title
G Merkel,C.David MD
Address
19 Church Street,Saranac Lake,NY 12983
Death Certificate Filed District Number Register Number
City, Town or Village Town of North Elba 1560
❑Burial Date Cemetery or Crematory
April 4,2012 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
co
0 Date Point of
N Transportation Shipment
p by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M.B. Clark,Inc. 01075
Address
2310 Saranac Ave.,Lake Placid,NY 12946
Name of Funeral Firm Making Disposition or to Whom
I_ Remains are Shipped, If Other than Above
2C Address
W
a
Permission is hereby granted to dispose of the human re s de ibe above as indicated.
Date Issued 4-4-2012 Registrar of Vital Statistics Ca.4u ! � Z /
(signa re)
District Number 1560 Place Town of North El a
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
ui Date of Disposition pork (,roil Place of Disposition ,,,,(kw c.r orn.-.
W (address)
N
(section) (lot number) c (grave number)
faName of Sexton or Person in Charge of Premises ir;Sfiyli r J iv-41—
w (please print)
z
Signature /4L Title .
(over)
DOH-1555(02/2004)