Wellborn, Manuel �3
-------------------------------- - - ---- -
TOO" or- MiGeNS Y
PIt_ VIEW MtwTenv
a
CREMATORIUM
Guaek*r- Road, Queensbury* New York 12a04
Phan* (516) Creaatori-um 74�1-4417 or if no answer
Crmetery 743-4416
AUTHOOIZATIEW TO CREMATE
Tho und*e*i,grsod r►oquests amd authowi2as Ptive View Cramatortm*. in
accordance with #ftl %4bj*ct to its flutes *nd Regulations to
crTmSte the remains afx
!kII = Manuel ale
Mass)
104 M' Ave. ktc. 10k aa.lotvb 1 �#�
(5tre0t) (City) fststs} (Zip C*da)
who d l ad on dasy itf' Oct. l9 96
API ace} t#�rtdresss
T4*x* and addross of dearest living relative or man* of Person
autrtorizi"O craaatar,n�
Jame S. 1149Y1uell 3'1I'7 Jill talle, LaW"♦ Ca. 01941-7501.
Mae*) tAcldrots�
1toletlorsshttp 4_9 they deCease.d SON
Masi# of Funeral rtoae A frGnd8ck crewtion Usociates, WarEOEbut ,MY 12885
3 reprosont that to that bast of my 'knowledge, the doceissed )ft%XX=
hiss r~O Pacemaker En Isis w- Nor body, (Ci.riclo O"o)
l certify that I have the f ul I pvveer and autneri,eat i are to arrsnVv
for the cremation of the remains and to direct the di spos it f nr. of
th* cr**a►tod r►omains„ that any Isaroomkl Possessions have atther
boon 3rs+soved or may be dcstruvu4, and agree to garotsct, d*Fen6
and saswa harmlatj Pint View Crema►taw#um from any aind all claim's
^no daalkods for loss or damages Nhich may be made a.gaaihs•t them lay
7"voten of iar connected with the 'cremation of Saia rexain% as
dirtCtedt whathvr such claims or demands are or err► "at wholly
groundless, fta1,4A or frattdu2, nt"
t#�1'trt���? ., i€3s�t}r•pltfii
ti619nJ fa41- d�
it-ive or L rgal llep. and Aditrv*0
Signod an this datga Oct. 61 1.g96