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McKinney, Thomas Maileff .C..t. _Het—F.... . 346 94 OF HEALTH - Transit Permit NEW YORKSTATE DEPARTMENT ,,� Burial 1 Bureau of Vital Records Name First Middle Last Sex Male Thomas Maileff McKinney Date of Death Age If Veteran of U.S.Armed Forces, 08/23/2023 79 Years War or Dates Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address Glens Falls Hospital W Manner of Death Undetermined Pending `p Natural Cause Accident Homicide Suicide Circumstances Investigation W Medical Certifier Name Title d Christopher Smith MD Address 100 Park St,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number 396 City,Town or Village 5601 RBurial Date Cemetery,Crematory or Facility Name 08/26/2023 Pine View Crematorium Entombment Address ©Cremation Queensbury Town,New York UDonation ZO❑Removal Date Place Removed — and/or and/or Held E Hold Address N 0 Date Point of U)❑Transportation Shipment _ d by Common Carrier Destination Disinterment Date Cemetery Address Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Carleton Funeral Home Inc 00281 Address 68 Main Street,P.O.Box 67,Hudson Falls,New York 12839 Name of Funeral Firm Making Disposition or to Whom F- Remains are Shipped,If Other than Above 5 Address Et W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 08/25/2023 Registrar of Vital Statistics Megan No(in(E(ectronica((y Signed) (signature) District Number 5601 Place City Of Glens Falls I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— Z Date of Disposition 8 eq 4,e7 Place of Disposition ?aC (1i/4-,,J ci-r.,?i,44O 111 2 (address) W CCCC (section) (lot number) (grave number) 0 Name of Sexton or Person in Cha e of P e i s A V P ia..4 Ti.) L�dd c/ z (please print) W Signature 4 J Title dPeT I DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered on , 20 Pine'View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#