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McKinney, Doreen H pc- NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Doreen H.McKinney Female Date of Death Age If Veteran of U.S.Armed Forces, 02/20/2023 73 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Lake Luzerne Town Street Address 359 Lake Avenue, Lake Luzerne Town, New York 12846 W p Manner of Death ❑Natural Cause Accident Homicide Suicide Undetermined ❑Pending Circumstances Investigation WMedical Certifier Name Title II] Anthony Petracca MD Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed Town Of Lake Luzerne District Number Register Number City,Town or Village 5656 1 Burial Date Cemetery,Crematory or Facility Name 02/21/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 0�Removal Date Place Removed and/or and/or Held N Hold Address 0 0. Date Point of (A Transportation by Common Shipment Carrier Destination Disinterment Date Cemetery Address Date Cemetery Address Reinterment Permit Issued to Registration Number Name of Funeral Home Brewer Funeral Home Inc 00211 Address 24 Church Street PO Box 500,Lake Luzerne,New York 12846 Name of Funeral Firm Making Disposition or to Whom H Remains are Shipped,If Other than Above 2 Address Q W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/21/2023 Registrar of Vital Statistics Cynthia Sherwood(Electronically Signed) (signature) District Number 5656 Place Town Of Lake Luzerne I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: Z Date of Disposition Z)2Z ivs Place of Disposition .�, .�/,, �✓f"f`—� (address) w CC N (section) (lot num (grave number) 0 Name of Sexton or Person in Charge of ises Z please print) IP W Signature % Title l2 DOH-1555(o7/18)p t of 2 72 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 • Pine View Cemetery Representingthe funeral home named on burial permit Official Funeral Directors Reg.or License#