Howard, Jacqueline Town of Queensbury
ur
Certification of Cremation
VArif
Pine View Cemetery and Crematory
This certifies that the remains of: Jacqueline Howard
were cremated on March 16 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death March , 12 20 22 Age 87
(Month) (Day)
Funeral Home Baker Funeral Home Registered No. 238
(Authorized Signature)
HOWARD
NAME Jacqueline Howard Age: 87
Lot Owner: David & Jaqueline Howard
Lot# Erie 25D Grave# 1 A
Case: Urn
Died: 3 .1 2.2 2 Interred: 6.2 4 .2 2
Funeral Home: Baker FH
Cemetery: Pine View
NEW YORK STATE DEPARTMENT OF HEALTH -i—
A Z3g
Burial - Transit Permit
Bureau of Vital Records -
Name First Middle Last Sex
Jacqueline Anne Howard Female
Date of Death Age If Veteran of U.S.Armed Forces,
03/12/2022 87 Years War or Dates
H Place of Death Hospital,Institution or
Z City,Town or Village Glens Falls Street Address Glens Falls Hospital
UJ
111
Manner of Death El Natural Cause EAccident Homicide Suicide Undetermined ❑Pending
Circumstances Investigation
W Medical Certifier Name Title
C Sean Bain MD
Address
100 Park St.Glens Falls,New York 12801
DeaEth Certificate Filedy Of Glens Falls District Number Register Number
City,Town or Village 5601 161
Burial Date Cemetery,Crematory or Facility Name
03/15/2022 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
Donation
0❑Removal Date Place Removed
p and/or and/or Held
N Hold Address
0
d Date Point of
N OTransportation
$ by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
ElReinterment 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
H Remains are Shipped,If Other than Above
2 Address
CC
W
O. Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 03/15/2022 Registrar of Vital Statistics Megan Nan(Ekctmracall f SYgne)
(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:
~ Disposition �,�L ,c`Z Date of Disposition 3 l 22 Place of
W
2 (address)
fi1J
N
Q (section) / (lot number) (grave number)
8 Name of Sexton or Person in Charge of Premises L ILI L...
Z /�D (ple se print) r
W -04
Signature [.� Title lP��l l
DOH-1555(07/18)p i of 2
J1 5t4 t
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#