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Gusek, Theodore H *it Mount Anthony Cremation Services le"4' 628 Main Street Bennington,VT o52oi 802-442-2516 Certificate of Cremation Number: 22111 I hereby certify that: Theodore Heinrich Gusek Was cremated at Mount Anthony Cremation Services under the observance of all legal requirements on 2/18/2022. The date of death was: 2/9/2022 Place of death: Albany,New York Funeral Home: William J.Burke&Sons Funeral Home P (���✓� Signed: - wa. e- r Administrator AL GUSEK NAME Theodore H Gusek Age: Lot Owner: Timothy & Kathleen Gusek Lot# Horicon 1 3 C Grave# 3 Case: Urn Died: 2.9.2 2 Interred: 6. 1 3 .2 2 Funeral Home: Mount Anthony Cremation Services Bennington VT Cemetery: Pine View GUSEK Owner Timothy & Kathleen Gusek Address Plot 732 County Route 16 Fort Ann, NY 12827 Horicon Phone # Lot # 518-260-3451 /518-639-8916 13-C Deed # Date 4091 10/16/2018 Cost Foundation Y - N Location Bounded to the West by Path, North by Vacant East by Congel, South by Tobias Remarks i/ - " ( _�/rtip_; Record of Interments 5 -� )t r e ��,1�- 1� 3a 6 6: 5 3 i1 k& --u3�✓ l I aD 8 e� L.Q •‘?" as 9 4 5 10 -T- ,� V wr 0 a ti S c0,,5�