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Sunberg, Franz Oscar Town of Queensbury ;i Certification of Cremation � � Pine View Cemetery and Crematory This certifies that the remains of: Franz Oscar Sunberg were cremated on November 29 20 23 at the Pine View (Month) (Day) Crematorium, Queensbury, New York, and these are the cremated remains of said body. Date of Death November 23 20 23 Age 91 (Month) (Day) Funeral Home Baker Funeral Home Registered No. 953 • (Authorized Si nature) SUWDBERG Lot No. 619 Address Cronin Rd. , Glens Falls, N.Y. liCN Section No. 27 Owner Franz H. Sundberg and Anna Sandberg Plot a/4 -T -w a Date 11/17/52 400 Superficial ft. @ $1.20 per sq. ft. Location Bounded on north by path; on east by vacant lot; on south by Algonquin Ave. , on west by Harkness lot . Corner Posts Remarks Deed No. (and changes) 619 Payment Record Paid in fill 11/17/52 g of ��n2. -1 LL 5 \lc aS f12 0 S v,f l 4oc. �o�n L- �i^�� ^va- of Form No. 01 Record of Interments 12 fr-Baby Girl Sundberg (11/17/52) V5 5 6 �_ ►-�� S r.,' ' r- Q lcxN- 7 Ik Tyrus R . Sundberq 3/20/00 (CREM) 8 f-rGn Z ‹)Nnc ► c> �S t I a3-a3 • f '�f7h` 0 11111 .21 0-G'/vc) c i N Ave;-_- ' SUNBERG NAME Franz Oscar Sunberge: 91 Lot Owner:Franz & Anna Sundberg Lot# Wah Tah Wah lot 619 Sec 27 Grave# 4#1 Case: urn Died: 1 1 .2 3.2 3 Interred: 1 1 .3 0.2 3 Funeral Home:Baker FH Cemetery: Pine View .,_ •,r, Lit. (A115 ./ NEW YORKSTATE DEPARTMENT OF HEALTH Bureau of Vital Records Burial - Transit Permit Name First Middle Last Sex Franz Oscar Sundberg Male Date of Death Age If Veteran of US.Armed Forces, 11/23/2023 91 Years War or Dates 1950-1972 t— Place of Death Hospital,Institution or Z City,Town or Village Glens Falls Street Address 8 Carleton Court,Glens Falls,New York 12801 W Manner of Death Undetermined Pending W Natural Cause Accident Homicide Suicide g Circumstances Investigation W Medical Certifier Name Title 0 Laurie Dennison NP Address 3 Irongate Center,Glens Falls,New York 12801 Death Certificate Filed City Of Glens Falls District Number Register Number City,Town or Village 5601 548 EBurial Date Cemetery,Crematory or Facility Name 11/27/2023 Pine View Crematory Entombment Address ©Cremation Queensbury Town,New York Donation 6❑Removal Date Place Removed and/or and/or Held F- Hold Address CO 0 O. Date Point of Cl) Transportation Q by Common Shipment Carrier Destination 11 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 t` Remains are Shipped,If Other than Above 2 Address c W a Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 11/27/2023 Registrar of Vital Statistics Megan No(in(ECectronica(y 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 ik.)-Z u"r vZ3 Place of Disposition ,JC? V 1 et.d C r ,AV r ILI 2 (address) W n CDl (section) —� (lot num r) (grave number) SI��,y,u1' t� t vv zName of Sexton or Person in Charge of mi es �'';—� ir (please print) W Signature 15f Title t'�'a DOH-1555(07/i8)p 1 of 2 Public Health Law Sec. 4145(2b) Receipt Human remains of ' ' J ` delivered on , 20 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#