McKenzie, Michel IZre
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Michel McKenzie Male
Date of Death Age If Veteran of U.S.Armed Forces,
11/22/2020 74 Years War or Dates
Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
11)
p Manner of Death ❑X Natural Cause ❑Accident El Homicide ❑Suicide ❑Undetermined Pending
W Circumstances Investigation
()
W Medical Certifier Name Title
CI Ibrahim El Halabi MD
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 2477
❑Burial Date Cemetery,Crematory or Facility Name
11/30/2020 Pine View Crematorium
❑Entombment Address
X❑Cremation Queensbury Town,New York
ElDonation
ZO Removal Date Place Removed
and/or and/or Held
Hold Address
0
d Date Point of
Cl) ❑Transportation
p by Common Shipment
Carrier Destination
❑Disinterment
Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Compassionate Funeral Care Inc 00364
Address
402 Maple Ave,Saratoga Springs,New York 12866
Name of Funeral Firm Making Disposition or to Whom
F. Remains are Shipped,If Other than Above
Address
CC
W
n' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 11/24/2020 Registrar of Vital Statistics Dana&SC,ilrerpre(Electronicall:yStgned)
(signature)
District Number 0101 Place Albany, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
H / ,
Z Date of Disposition 11130/i Place of Disposition ZA N` l �-
2 (address)
W
CC CC (section) 71 (lot number) (grave number)
Name of Sexton or Person in Charg, o remises �ft"'1 �
Z (ple4se print)
W Signature �- Title 60'(M
DOH-1555(07/18)p 1 of 2
Public Health Law Sec. 4145(2b) 01 4242 1
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#