Walker, Robert TOWN OF QUEEVBUNY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director -/Lt'01V CI C&�M& /dff
Name Case #
Date of Crematicn Z�— O -
Time Cremation Started
r
Time Cremation Completed
Type of Container
Remarks :
/9 M
11/14/9! 1J:Ju rnd cuc rcc aaru u013An nn%. Wd uui
F720M ALE)(Ah4DEF2 FLINERfL- 1-ICh¢5
ENE NM = Nov. 14 1997 12:MPM P2
T[7hM� Orr QUE EMSBURY
pINU dZEM CEWTERY
i
CReMATO R I UM
pual+eY` Road, puQenVbury, New York 12804
Phone (S1Ei) Crematt'ori%a7 45-4 4 7 7or if no answer
G;vmatery 6
AUTHORIZ(%TION Tq CREMATE
The underslgmed requests knd autnorizes Pine View Cremator%um. in
ACeordance with and subject to its Rules and Regulatians to
eMQmate the remains Of! .
Male
Robert
(Name)
US SoldiGrB' & lkirmen'c Fib. g70Q N.Capitol St_ NW,Weshfrigtsoci.DC 20317
{City} lgtate) %LIP Dade?
97
t5ttr5`eL]
who died an
12th day of NOV. 14
at Hotly Tree Inn, Larva George, 1V- I284�
(Place) (Addy-45e)
t4a,ae ar►d mddrese of nearest living relative ar nadf of pQrSOn
authorizing erematiorra
rnme - M� a r Mort. HaMW
ofYicie�'-Soldiers'
PrinE yt�t (Address>
(Name)
d
to the decease Mott Officar
Relationship �
Mao! of Funeral Moore Adirondack crematiam �,saociatea,
IMppRTAMT= kanawle e* the daceaswo ]
I represent that to thQ best of o d(C-Irc4lr One)
ha►r. no. paC'emaker in his or hrr body.
I certify that I have the full power and au*},arthe din to arrange
for the C'r•ematXRn air thR remains ern'sonol to dirOct
Paysedsio,tisy have teather
the Ceem.0tod roaains, that .any P ree� to"protect, defenn
been r■moved or may be "destroyed, ano ag all claias
amid save hai-mlP=r Pine Viaw Cr c
eaa6Oriu■ fr 11. any and -t them by
it�a demands for Lass or daRages which may br mah a9
ro�san ''`of or Connected with the Cremation of Said remains as
tlir Ct ed, wh other LuCft:- C3,aims or damands mrw--=ybr are_.not who 1 1 Y
r.vun e s false or fraud'ulent-
arren burg, NBC
Ines ) (A dress)
WiI§
nature of Relat ar Lepal Rep. and AdQross]
11-14-97
Signed an this date:
11/14/97 12:51 TX/RX NO.7918 P-002