Jannon, Edward L4
OF QUEEN5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ l�rli,,cf
Name Erlwti,J
`"""0 Case# 391
Dace Of Cremation 5 f 4� 2op7
� r
Time Cremation Started t2�. �{b 1.
Time Cremation Completed a"to
Type of Container_
Remarks
M 8 1�W 1 -.Cy RI 1 r�►� .l� I �s1�`i
3 vo�
3� )
Town of Qumwbwy
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York. 12804
Ct metwy Office:(518)745-4476,Crematorium: (519)745-4477
Audwization to Cremate
The utderakpled raqu®sis and autwiaes Pare View CrWootoritrm.in accordance with and subject to RS RUIes and ROQUb dions to
cnwiWe the r of
G�u)axrl L . Ta_v nor, Mo-In
(streeQ (cft►) (fie) (zo code)
who died on `�3� 1 t da��lyd 2oQ7
at S0_.r'a_47Bock � 401 Y, YY G( :5,1['� Q�
(Plow) Ili ( ) J
Name and ad&ew Of rtaatttst MV feICY@ Or rtarlta cf peF=a*Mrh*Q GT!llrit#i=
LI l t a ;n� IBC( —
) ---
(Nww) J
AWaWneWbthedeceased
Name of Final Florae Za2Ck C,C IlL Q rri ( 1: }f7 l t)C .
IMPORTANT:
I rep emo that to the best of PW bwwledge,the (has)or(has no)pacenrWw,deftrilator or wW adrer battaty operated
drAw in tna or her body. (Ckc*One)
1 aerflfi►#W 1 have fir@ power and aldwft ation t3o ewa W for the asnadw of the remains and to ditert the drsposition of the
cremated reawina,that aoy personal possessiarrs have either been remowsd or may be desboyed.and aww to protem delww and
save hatrriless Pate View Qoea aWkm room ant►and ar dears and demands fa tam ar damages whidt teal►be made aQaitst ftm
by reason of cr carrrected with the aerrteti n d said sa directed.whatlwr such a demands are a are act wt►oRy
(vYI>naee) ✓�� ( �
(Si�raLne and of RWa*m or tAgW Rapmserftoe)
Sigred an this date: O_l6b f�^]
Disposition of Cremetiad Remains
i hereby d'aect Pare View C emetairue to dhpoee of*w aenreted renmWe os foaows:
mom to —
Omer sffwVwneM-Pmese eperify:r1r a P in -�t tJ' c rn I
if p*eon of atxrwW mobs s is necprasted.dttxk here Y
tteviWom Jamery 1,21t O