Schwarzenbach, Fred TURN OF QUEEV B 2 9. Y
PINE VIEW CEMETERY/AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director M/7/1-1/t/1 15
Name �/1�1/ ��;"d .Z'6ygj/7c.y Case #
Dat e of Cremat i cn —J-6 —q 1
Time Cremation Started ���OZ/�//1�
r
Time Cremation Completed t'r M t
Type of Container Cd9,9U6dAl2
Remarks :
,41 i4i N 90/A09-9
l� 11 ����-3Ei il►� J
` TOW OF ODUMBSURY �
PINE V I9M CEMB,TERY
E
CRENR C OR IUM
Quaker Road, Gveensbury, New York 12804
Phone (51 p) Gr,gtrat or i uet 745-4477 or' if no answer
Ceeetery 7413»4476
AUTHORIZATION TO CREMATE
(tie und.r.ignad rpquesti and authorizes Rine View Crms+atoriumq to
aceordenae with and subject to its Rules anti Ropulativilr to
aroma%• the ramains oft
(Name) (Sax)
Na�S�' ran hP a �IQ ti y
treat ► (City)
(80ate► ,alp trope,
who d f eri nn _ ) l�.day 0f 1'
at e- HZ—' , I
(Aiace) J (Address)
Notre and address of noarest living relative Or name Of prrsvti
authorising creaat2ons
r
fla Lj -7�;j �. 332 t s� p Jvc
(Na o) ddrmss) OG e�S�
V6A -7/6 342- I L431
ReYetionshtp to the deceased
Name of Funeral Nose x A ✓/N'S /a/!� �+r..
ZlPDR1'AN?'t
i represent that to the host of ■y knowIedge, the deceased has or
hat no partook or in his or her body. (Circle One) /Jo
I certify that I have the full power and authorization to arrange
for the •remotion of the remains and to direct the disposition of
the cremated re.atns, that any personal r possessions have either
been removed or mar be destroyed, and agree to protectr defend
and save harmless pin. View Cresiatoriun from any and all claies
and demands for loss or deveges which may be rods against them by
meson of or conr+ovted with the cremation of said remains as
directed, wh t or• such claims or demands are or are not wholly
greundl s, sc or fraudvlent.
twit ass) tQdci as)
ti0natur of R 1 tive or Legal Jlep. Ono Address)
819ned on this d.t.t . .