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Steves, Jeffery Michael Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Jeffery Michael Steves were cremated on February 28 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 17 20 23 Age 34 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 192 0-7 (Authorized Signature) STEVES q_imf;) NAME Jeffery Michael Steves Age: 34 Lot Owner: Wesley Steves Lot# Mohawk #1 66 Grave# 2A Case: Urn Died: 2. 1 7 .2 3 Interred: 3. 6.2 3 Funeral Home: Baker FH Cemetery: Pine View NEW YORK STATE DEPARTMENT OF HEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Jeffery Michael Steves Male Date of Death Age If Veteran of U.S.Armed Forces, 02/17/2023 34 Years War or Dates Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address Glens Falls Hospital 'p Manner of Death a Natural Cause IllAccident Ei Homicide Suicide Undetermined Pending J Circumstances Investigation W Medical Certifier Name Title 0 William Parker MD Address 9 Carey Road,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 106 Burial Date Cemetery,Crematory or Facility Name 02/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation g❑Removal Date Place Removed and/or and/or Held F Hold Address 0 O. Date Point of f/) Transportation p by Common Shipment Carrier Destination EIDisinterment 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 l— Remains are Shipped,If Other than Above 2 Address W a. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 02/27/2023 Registrar of Vital Statistics Megan Nolin(ECectronicalTy 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: UJ � W Date of Disposition 2)Zg rz3 Place of Disposition "l —(L (address/ W N CC (section) (lot number,E- (grave number) g Name of Sexton or Person in Charge of Premises t'1(please L \�};r. t 11" Z / print) W Signature /L Title � ►W� DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1 Receipt Human remains of delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License# Form No. 01 Record of Interments 1 Linda Steves (1/9/R1 ) 15 2 Wesley Kirk Steves ( 1 2/6/1 3 ) 6 ,AI ��FF�. f Skuz5 3 4,9- o,6 . a3� 4 8 X • MVPS (11111) Lot No. 166 Address Woodard St., Glens Falls, N.Y. Section No. Owner Wesley Steves Plot Mohawk Date 1/9/81 67 Superficial ft. @ $250.00 Location Bounded on the North by Vacant, East by Vacant, South by Hartman, West by road Corner Posts Remarks Deed No. (and changes) 1631 Payment Record Paid in full 1/9/81 2 \ 5'd -co e/- G���J