Hidley, Ralph 70NIN OF QUEEVBU_eY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Name // / Case #
Date of Cremation 37 4n,
Time Cremation Started
Time Cremation Completed
Type of Container
Remarks: ��
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FROM i FRY REGLET INC ,��o.c,o-=i K• .�
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GemWtary
quTNpaIZATidN TO C11EMOTE
in
and Pine V RN9vtatiOMs� to
'thy undorsigned requests igatautoa es its quIct and
aCCordanea Kith and
cremate the r*aaine at,
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30 day of !!a
Mho died on a+ NY
Health Case Canter
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at Wesley tgddrrse�
�place) person
i address of nearest living ralstise
Name and add
or Hate of
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autfioritiAG erewatient
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RelitlonshlP tR the dot;�astd
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Barton
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Name of freNtral MOIRa
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IIwaltim"TI beet of my knbNI24I91 *h• deeeated he% or
I rwPr'rtent that to the iCirel•.Gnel
i has no pMeoaaker in his or her body' un to v%r6F'#v
doer and aather}h�tdispof+ition oP
! i earti}y that I have the full R nd to diraet
the Cram&tton of the remains 'rsonsl poftassions havt Wither
for
that O"v P and ,agree to protect, deffhd
the cr§P&%Od reaait+sba dtstrdyed, ., and ail claim~
' boa" rarovod or may View Grer+toriva {be*red* ap&inst them by
and save harm 0ss Q n r damages Which Say remains rf
and demand~ for iv s ehe �rRaation of said wholly
reason of er Go"n•c ad wikh deMends art or art not
diroet wh her. • r eieit,f+ or
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proun Ws3� t � ���..tit d ''v�
(pddressl
t�titnessi
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ra end Addwe9
✓/� ttenatura • ♦tire or Lao
Signed on this atat
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