Patnaude, Robert TOq1 N OF QUEEVBU-WY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY. NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director e� d, i
Name &Z �� //GGU��Case # !/
Date of Cremation
Time Cremation Started / qy')
Time Cremation Completed I, 7- ' tNl
Type of Container
Remarks :
1
i
' TOWN. of OUEENSDURY
p IM v IEN L;E,METERY
CREMATORIUM
Q,,aµer �oac1, Quovnsb.urv. New 10rk 3 8Q)4
Dhane c18) 0r•enatorium 74Z-4477 or if no answer
Cemetery 74�»4476
fAUTHORiZATION TO CREMATE
int View Cre.ptatorivav to 11
The undersigned rcaussts and authcrizesRuleS end Recjulat•zvn8 to
accordance wltlm and I ,uoJecC'~ to its
crenate the rraa.,ns of
Patnaude Male
RoUeE c, 0J tSe++)
tName) 12831
22 church Street
�Gtreet)
(City) sta r) 'ip Cvdv)
Who died on
2 day of Januar 14099- ---
at NPW
Eden Par Glens Falls
(Place) (Address)
Nave and address Of nearest living relative or ' name Of pew°scri
dµthoriting Crema)tlOnt
Barbara 150 Washburn R 12871
CNaMN) (Address)
Relationship to thv deceased Dau h er
Nang of Funeral kcme Wm. J. Burke & Sons
I MMRTANT
I represent that to the best of my knowledge, the deceased has or
has no paeeaaker in his or her body. 4Cirele One)
I certify that 1 have the full power and authorization to arrange
for the, cremation of the remains and to direct the disposition Of
the cremated remashs, that any personal possessions have either
been removed or may be destroyedg and agree to protect, defend
and save harmitss pine , vie«!:_re.!4ktiorius ..frea any and all claims
and demands for loss or damages whfCM may be afadv against them by
h'' the cremation of said rtR*1ns as
reason of or cannectrd wit
directed• whether such claims or demands &y*v ;Qr are,-,not y
groundless false or fraudulent. Will:,
urk
4V ;
(►� ess) �,�;,� 4-5373
150 Wash sevoort,
(signature of Re atiRep- and. Address)
Signed on this dater JaN. Jan. 4, 1999