McKinney, Caysen A sg-)
NEW YORK STATE DEPARTMENT OF HEALTH - r - Burial - Transit Permit
Vital Records Section
Name First Middle Last Sex
CAYSEN MCKINNEY FETAL
. - Date of Death Age If Veteran of U.S.Armed Forces,
7/15/2021 FETAL War or Dates
} Place of Death Hospital, Institution AMC
2 City ,Town or Village City of Albany or Street Address
pManner of Death Natural Undetermined Pending
FETAL 1-1
Cause El Accident ❑ Homicide ❑ Suicide El Circumstances ❑ Investigation
Medical Certifier Name Title
q CORINNE MCLEOD MD
Address
43 NEW SCOTLAND AVE, ALBANY NY 12208
Death Certificate Filed District Number Register Number
City,Town or Village City of Albany 101 FETAL
Date Cemetery or Crematory
❑ Burial 7/19/2021 PINE VIEW CREMATORY
0 Entombment Address
®Cremation 21 QUAKER RD, QUEENSBURY, NY 12804
Z Date Place Removed
Removal and/or Held
g ❑ and/or Address
F Hold
Date Point of
p, Transportation Shipment
❑ By Common
Q Carrier Destination
❑ Date Cemetery Address
Disinterment
El Reinterment Date Cemetery Address
Permit Issued To Registration Number
Name of Funeral Home M. B. KILMER 01079
Address
136 MAIN ST, SO. GLENS FALLS, NY 12803
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above a indicated.
Date 7/19/2021 Registrar of Vital Statistics G�ts - 71-(--,,,
Issued (signature)
District Number 101 Place City of Albany, NY
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition 1 I 10171 Place of Disposition w.t1-- 40----
ta (address)
W
to
CL
O (section)
(lot n ber) (grave number)
Z Name of Sexton or Person in Charge of Premises �- S " t
to4; C f,.
ase print)
Signature Title G
goofw
(over)
DOH-1555 (02/2004)
Public Health Law Sec. 4145(2b) N 0 14 9 5
Receipt
Human remains of delivered on , 20
'1 Pine View Cemetery Representing the funeral home named on burial permit
i Official Funeral Directors Reg.or License# • ,L.