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Lobdell, Rickena Anne Town of Queensbury Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Rickena Anne Lobdell were cremated on March 24 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death March , 18 20 23 Age 74 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 279 r•FT- (Authorized Signature) ) Pr) 11 NEW YORK STATE DEPARTMENT OF H EALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Rickena Anne Lobdell Female Date of Death Age If Veteran of U.S.Armed Forces, 03/18/2023 74 Years War or Dates ZPlace of Death Hospital,Institution or City,Town or Village Glens Falls Street Address 25 Sanford Street Apt. 1, Glens Falls, New York 12801 p Manner of Death ❑X Natural Cause Accident ❑Homicide Suicide Undetermined Pending Circumstances Investigation W Medical Certifier Name Title G Paul Bachman MD Address 9 Carey Rd,Queensbury Town,New York 12804 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 152 Burial Date Cemetery,Crematory or Facility Name 03/23/2023 Pine View Crematory Entombment _ Address ©Cremation Queensbury Town,New York Donation 8❑Removal Date Place Removed and/or and/or Held N Hold Address 0 O. Date Point of U)❑Transportation s 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 i.. Remains are Shipped,If Other than Above a Address CC W a' Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 03/22/2023 Registrar of Vital Statistics Megan No(in(E(ectronica1Ty 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: Date of Disposition 3)ZN(13 Place of Disposition . 7 ti— D---- W address/ IW U) CIC (section) // L (lotnumber) S4 /grave number/ 8 Name of Sexton or Person in Charge o ises iNt "urn z please print/ W Signature Title rwnii ' DOH-1555(07/18)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of delivered o , 20 1 Pine View Cemetery Representing the funeral'home named on burial permit Official Funeral Directors Reg.or License# LOBDELL NAME Rickena Anne Lobdell e: 74 Lot Owner: Samatha Lobdell Lot# Algonquin Sec. F R # 87 Grave# 1 Case: Urn Died: 3 .1 8.2 3 Interred: 4 .2 0.2 3 Funeral Home: Baker FH Cemetery: Pine View LOBDELL Owner Samantha Lobdell Address Plot 25 Sanford St, Glens Falls, NY 128n1 Algonquin Phone # Lot # 518-256-2440 Sec. F ROW # 87 Deed # Date 4374 4 .20 .23 Cost Foundation Y - N $500.00 Location North- Vacant South-Toscano East-Vacant West-Vacant Remarks Record of Interments 1 cac� 3. IS� a3 6 2 7 3 8 4 9 5 10 a_ _1-\--1- laJ '� v