McKee, David William t s46IZ
NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
David William Mckee Male
Date of Death Age If Veteran of U.S.Armed Forces,
07/22/2021 76 Years War or Dates
l.. Place of Death Hospital,Institution or
Z City,Town or Village Albany Street Address Albany Medical Center Hospital
W
`p Manner of Death ❑X Natural Cause Accident ❑ Homicide Suicide Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
Rick Mclaughlin PA
Address
43 New Scotland Ave,Albany,New York 12208
Death Certificate Filed District Number Register Number
City,Town or Village Albany 0101 1786
Burial Date Cemetery,Crematory or Facility Name
07/26/2021 Pine View Crematory
❑Entombment Address
X❑Cremation Queensbury Town,New York
Donation
ZO El Removal Date Place Removed
and/or and/or Held
N Hold Address
0
C- Date Point of
Cl) 11 Transportation
p by Common Shipment
Carrier Destination
Date Cemetery Address
❑Disinterment
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home M B Kilmer Funeral Home-Fort Edward 01079
Address
82 Broadway,Fort Edward,New York 12828
Name of Funeral Firm Making Disposition or to Whom
1— Remains are Shipped,If Other than Above
Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 07/26/2021 Registrar of Vital Statistics DanielleScillerpre glectronicall:y Signe4
(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:
IH
Z Date of Disposition 'X7--ram:-) Place of Disposition tK y jLAJ crc."44erY
2 (address)
W
CC CC (section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises cJ pfH+�' 'Stvrc,S
Z (please print)
W Signature Title C-re,rlSyor
DOH-1555(o7/18)p t of 2
IF
Public Health Law Sec. 4145(2b) -- 014980
Receipt
Human remains of delivered on , 20
Pine View Cemetery Representing the funeral home named on burial permit
Official Funeral Directors Reg.or License#