McKinney, Donald NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Donald McKinney Male
Date of Death Age If Veteran of U.S.Armed Forces,
.-s::, September 2,2012 84 War or Dates
i'::
Place of Death Hospital, Institution or
: City, Town or Village Queensbury Street Address 48 Montray Rd.
ti Manner of Death I j1 Natural Cause Accident n Homicide Suicide [1 Undetermined Pending
t. Circumstances Investigation
Medical Certifier Name Title
A; Joseph Mihindu,MD
Address
1v:, 20 Murray Street,Glens Falls,NY 12801
p Death Certificate Filed District Number Register Number
, City, Town or Village Queensbury Sit Si ill
D Burial Date Cemetery or Crematory
❑Entombment September 4,2012 Pine View Cremation
Address
®Cremation Quaker Road, Queensbury,NY 12804
Date Place Removed
z n Removal and/or Held
and/or Address
H Hold
N
0 Date Point of
Si n Transportation Shipment
p by Common Destination
Carrier
ri Disinterment Date Cemetery Address
(-1 Reinterment Date Cemetery Address
Permit Issued to Registration Number
:': Name of Funeral Home Regan& Denny Stafford Funeral Rome 01443
Address
: 53 Quaker Road,Queensbury,NY 12804
Name of Funeral Firm Making Disposition or to Whom
r Remains are Shipped, If Other than Above
yE. Address
lit
` ° Permission is hereby granted to dispose of the human remins described above s 'ndicated.
Date Issued el-c- d-o I -:.._Registrar of Vital Statistics Att�,c_ii
(signature) ----_
District Number sic,S,-- Place Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z /g � C W Date of Disposition `1-S`IZ Place of Disposition , w.., � +rya...
W (address)
U)
QtY (section) /} lot number) S+�,.�' (grave number)
Name of Sexton or Person in Charge o Premises `i n3 0
Z (please print)
WZ4L—Signature Title CVt, M►ctl'O(L-
(over)
DOH-1555(02/2004)