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Seelye, Edward T07+N OF QUEENs5BUP.,Y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director �f /y! D� P.) Name )5c/4)) AN Case # � Date of Crematicn � Z2 Time Cremation Started c0 /IY I j s ,�f Time Cremation Completed Type of Container ©©1] dJCe �✓ / r G/ls� Remarks : A1,41,N 901ywR-9 Ada zl,E-p r �1 �1 �i )'q ,M t..r a -p( 7 n• I f` r CT'; :I �u.W tt74.1N or UtJMNSHURY ratty VXF_W CEMETEPY It rr��r�aYort can Quarter !toad, uPpnsbtrryr Nrw Yvrk la*" Pane i5t8) GrwatJ�cvri�as 745-4477 or if r•a a"xWNr ' C.'lmrtcry 7�9--4k76 ' gUTHUR t ZPT lUN TU r:'RF.MA'rE Thw undersigned reavestas n+srd xuthMr9.zts pino e Virw Crrssnatoriu«• in Accordanew with aril! sub,jett to its Rules and pepulatianal eremite the remains vFi _ jj 'i c i r y► _i-5!lair!R> t z t p cod r c (gtr•e+rkD T d a y "he died cn (Place) �(Adeirat* Napo and oddrttys of �worwIt living rslwllVN or Oil sf pa►r"lori orw 7�a;n+ �I• y;3sZ t: autharltin$ cv,,pstiont �.,�'G�Ci P1 i:�1� :AO'y'r_G I��OGt�LL�_�•, .2 S ry t Nw>w«� (Add r•a*x pel:ttiarrthlP to thr deaeiwed .1 No** of run«ra►l Honk— IpTpN7e my knuwiedge" the d,C*# od has or I rrpr'tsdceeth in hhe or t f herMbody. (circle one) has no p rr#n4e t a*rtify that 1 Lave the full Power end direct the}dfrpoei4!«n of for the rrssstlCn of the rwwtains and to direct that +anti personal passttr*lens hsys defend setrnyrd. end agree to proteci:" the Gremwted rea►.axns, nd ell c�alww beers roxv:ed or eay be View Crematorium fwpN any 4 then by and save "*rot*$% Pin* daaMwge% whit:h may be made againstRuin• •s end dtmands for toss or the orewat,ion of void with are not wholly rtasrrn of or con^tend Ialws or dempnde� are a►" directed. .hot"4r such K o r t. ad t►1 n t. F/ < •p 'dSf"N�/(�/! .Z�378 gran d7rva.�« �r tRddrfYs3 'N�2�. Ccrc..l ANC �tss�_� (Nitinryat Mareh't•°tC• '�'.� tf�ig up•t�p WRtlatiYlD ar' t-tg ,al Rep. one!• gdclressf ylpned an this �> ;�� 66• Z.e ant 10d Cos wc�