Madden, Steven Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Steven Madden
were cremated on October 25 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death October , 17 20 21 Age 59
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 881
(Authorized Signature)
K gsi
NEW YORKSTATE DEPARTMENT OF HEALTH Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Steven Robert Madden Male
Date of Death Age If Veteran of U.S.Armed Forces,
10/17/2021 59 Years War or Dates
H Place of Death Hospital,Institution or
WCity,Town or Village Wilton Town Street Address 61 Jones Road,Wilton Town, New York 12866
Manner of Death ❑X Natural Cause ❑Accident El Homicide Suicide 1:1Undetermined El Pending
Circumstances Investigation
W Medical Certifier Name Title
C Arthur Nolan Coroner
Address
487 Sandhill Rd.,Greenfield Center,New York 12833
Death Certificate Filed District Number Register Number
City,Town or Village Gansevoort 4569 55
Burial Date Cemetery,Crematory or Facility Name
10/22/2021 Pine View Crematory
El Entombment Address
aCremation Queensbury Town,New York
Donation
ZO Removal Date Place Removed
and/or and/or Held
H Hold Address
0
CL Date Point of
❑
U) Transportation
p by Common Shipmer
Carrier Destination
El
Disinterment
Date Cemetery.lddre.
El
Reinterment
Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Maynard D Baker Funeral Home 01130
Address
11 Lafayette St,Queensbury,New York 12804
Name of Funeral Firm Making Disposition or to Whom
F Remains are Shipped,If Other than Above
g Address
C
Ui
C' Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 10/19/2021 Registrar of Vital Statistics Susan Ballwin glectronicall Signed
(signature)
District Number 4569 Place Gansevoort, New York
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Z Date of Disposition /0/2S I1,t Place of Disposition 7.31a
W address)
W
CC (section) f(lot number) � (grave number)
Name of Sexton or Person in Charge of Pre ises C r`�jip1- -mot' ' 'k�
Z (please print) /
W efIst
Signature Title `` �
DOH-1555(07/18)p 1 of 2
j1 5 24
Public Health Law Sec. 4145(2b)
Receipt
Human remains of t ` delivered on i , 20
Pine View Cemetery Representing the funeral home nameq.pn burial permit
Official Funeral Directors Reg.or License#— ^ '`
MADDEN
NAME Steven Madden Age: 59
Lot Owner: Carol Madden
Lot# S&I #2 Grave# 3
Case: Urn
Died: 1 0. 1 7 .21 Interred: 1 0.2 7.21
Funeral Home: Baker FH
Cemetery: Pine View
MADDEN
Lot No. 110 B
Address 39 Longview Dr. Queensbury, NY 12804 Section No.
Owner Carol Madden Plot S . I. #2
Date 9/24/2010
Approx. 33 Superficial ft.
Location Bounded on the North by Vacant , East by Willmott , West by Jeckel
and South by Packard
Corner Posts
Remarks 792-2264
Deed No. (and changes) 3686
Payment Record Paid in full on 9/24/2010 ($600.00)
Record of Interments VA _AN T
t Robert P. Madden (9/25/20M0) Crem. �- v ,, II
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PACJ 2D
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Form No. 01