Eaton, Cassandra Irene 1475
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Cassandra Irene Eaton
were cremated on February , 14 20 23 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death February " , 3 20 23 Age 21
(Month) (Day)
Funeral Home Baker Funeral Ho Registered No. 151
/e(r
(Authorized Signature)
NEW YORK STATE DEPARTMENT OF HEALTH • Burial - Transit Permit
Bureau of Vital Records
Name First Middle Last Sex
Cassandra Irene Eaton Female
Date of Death Age If Veteran of U.S.Armed Forces,
02/03/2023 21 Years War or Dates
Place of Death Hospital,Institution or •
Z City,Town or Village Queensbury Town Street Address 931 State Route 9,Queensbury Town, New York 12804
'p Manner of Death Natural Cause Accident Homicide Suicide ❑Undetermined 71Pending
Circumstances Investigation
W Medical Certifier Name Title
CI Connie Goedert Coroner
Address
1400 St Route 9,Lake George Town,New York 12845
Death Certificate Filed Town Of Queensbury District Number Register Number
City,Town or Village 5657 20
RBurial Date Cemetery,Crematory or Facility Name
02/10/2023 Pine View Crematory
Entombment Address
Cremation Queensbury Town,New York
EiDonation
0❑Removal Date Place Removed
and/or and/or Held
N Hold Address
0
O. Date Point of
N EITransportation
b by Common Shipment
Carrier Destination
Disinterment Date Cemetery Address
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
2 Address
CC
W
a Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 02/07/2023 Registrar of Vital Statistics Caroline 7fi&fegarrfe Barber(ECectronicafty Signed)
(signature)
District Number 5657 Place Town Of Queensbury
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition z III (7,3 Place of Disposition
2 (address)
1U
(section) (.lot number) (grave number)
8 Name of Sexton or Person in Charge of Premi I
Z *ease print)
W Signature Title (w tuna
DOH-1555(07/18)p 1 of 2
r rr
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# t
EATON
Owner
Cassandra Eaton ( Social services)
Address Plot
7 Schoolhouse Rd, Queensburv. NY 12R04 Algonquin
Phone # Lot #
Na Sec C Row 4#11Q
Deed # Date
4369 2.9.23
Cost Foundation Y - N
$400.00
Location
North-VAcant
EAst-Vacant
South-Norton
West-Road
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: �> y :; r�t �/� C / ✓f DATE:
SIGNATURE: DATE:
Record of Interments
J6
2 7
3 8
4 9
5 10
.1. ,
,
G j, z
EATON
NAME Cassandra Eaton Age: )
a
Lot Owner: Cassandra Eaton
Lot# Algonquin Sec C Row 4 #11Q Grave# 1
Case: Urn
Died: cX 3. o?O)3 Interred2. 1 6.2 3
Funeral Home: Baker Fh
Cemetery: Pine View