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Guy, Francis 11.16 Town of Queensbury IOWA Certification of Cremation Pine View Cemetery and Crematory This certifies that the remains of: Francis Guy were cremated on July 6 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury,New York, and these are the cremated remains of said body. Date of Death July , 1 20 23 Age 72 (Month) (Day) Funeral Home Baker Funeral ome Registered No. 539 Z(0' (Authorized Signature) Guy st A'JtJ Lot No. 41 ddress .. E. i za,�7 r/ •LAC �`E� Bu�c Q�, Section No. C J v by•'307 l , , •-• ATV owner Roger R. Guy --}1 j LO 1 R r\-1 — 5 )6_ 77s r Plot Algonquin 6 IS- g oil- 2'74 2. late 8/28/95 Approx. 16 Superficial ft. mation Bounded North by Leporin , South by Vacant , East by Smith , West by Berry orner Posts emarks seed No. (and changes) 2 6 g 4 ayment Record Paid in Full 8/28/95 ( $17 5 . 0 0 ) ,ecord of Interments Le Poo Roger Guy 8/31/95 -- ainv r iC- Anna Guy 11/1/03 (CREM) kko C3 ® �-! n, � �'� gyp•a3 , �' C �S _. 310,11 i6 l4 1 0. 1 �`( y T k Vctcatvr D m No. 01 GUY _F) NAME Francis Guy Age: 7 2 Lot Owner: Roger & Dawn Guy Lot# Algonquin Sec. C # 41 Grave# 4 Case: Urn Died: 7. 1 .23 Interred: 7.1 0.2 3 Funeral Home: BakerFH Cemetery: Pine View # S3cl NEW YORK STATE DEPARTMENT OF HEALTHfo) _ ' Bureau of Vital Records Burial Transit Permit Name First Middle Last Sex Francis J.Guy Male Date of Death Age If Veteran of US.Armed Forces, 07/01/2023 72 Years War or Dates Place of Death Hospital,Institution or City,Town or Village Queensbury Town Street Address Warren Center for Rehabilitation and Nursing pManner of Death l Natural Cause Accident Homicide Suicide Undetermined riPending W Circumstances Investigation W Medical Certifier Name Title 0 Wendy Steinhacker PA Address 42 Gurney Ln,Queensbury Town,New York 12804 Death Certificate Filed Town Of Queensbury District Number Register Number City,Town or Village 5657 102 Burial Date Cemetery,Crematory or Facility Name 07/05/2023 Pineview Crematory Entombment Address ©Cremation Queensbury Town,New York Donation ZO Removal Date Place Removed and/or and/or Held F. usHold Address 0 d Date Point of N Transportation Shipment p by Common Carrier Destination O 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 1— Remains are Shipped,If Other than Above 2 Address CC uJ O. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 07/05/2023 Registrar of Vital Statistics Caroline Jfi&degarde Barber(Electronically 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: Z IU Date of Disposition 73 Place of Disposition ?FAIL eta.--, 2 (address) W CC (section) n (lot number) (grave number) Name of Sexton or Person in Charge of P ises n ' Z (/ase print) W Signature Title riGrAlrava DOH-1555(07/18)p i of 2 1 .. k ')3 7 I 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#