Schweins, Joseph T09+N OF QUEEVBU-1ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director' ` A / ' '/,- P
Name lk)J l/Y ? Case # t/f/
Date of Cremation i�� V�
Time Cremation Started
Time Cremation Completed
�j
Type of Container fit_ ,1 �S!1 X 1? /1�--
S
Remarks :
RONALD A MONTANA DD5 YR Yb 144 r6� rD
THU 10:53 AM SINGLETON HEALY FUKERAL FAX N0, 5187933641 F. a
#:�
TdW OF GUep-MOURY
p IW VIEW CEM 'tr-RY
a
CRO40TURIUM
pucker goad, gUeensbury, New York 12804
Phone t'Jl8) Cresatnriue 743-4417 Cr if no answer
Gesetery 745-4476
AUINURIZATION TO CREMATRts View Crosatoriva, in
The undersigned reauesV ubject to its and au%a it s Al Rulet s an d Regulations to
oreaedance "tih and s
Cr"e[mmate the remains Off rn �
tN at)
- � t5 t ) (Zip Code) qq
-
r.r•! day of
wme- died nn _
at (Address)
(Place)
NM&# and address pf nearest living relative O"' riame of person
uthdri 'ng crtsatigh=
r
(Naas) tpddress)
Relationship to the d�eeased 1
Name 4f Furoral Most
IWORTANTS to the bRst of sy knewlldg*� the deceased has or
= rtpemsent that or her tmy tClrele nne)
has no pacemaker in his
rtlr and aldtttor3■rt 1an to •�-• ant:r
,Certify that l gave th! full Pe ositinn of
# ..P tw• �.mmains and is dlrmet the difI.— eitsmor
for the a r`@d rwo that any person, pvsleto pr
be dlatroyed• and agree to pNet.eCt, defend
the areas re#ains, and at a claieS
bean reAOved or say view CrtoOtorius frog any
and Save harsless vine eS whit:h ,say be made against th gains aS
,�,,t �lemandt for loss or dasag of said
..to An a* ■r ConneCSTV ^i4.4. 4um r+rs�at10T1 no` "1101F
J1►-meovd. whether ouch CISIPI or Vewands are or
aF+e
groundless, false or frsutfu3e��t .
• �pY-e t s r
tMitn�rss) _ '
// •� �, MJr.p. and Address)
V tmae.etilre of f#+tine or
Signod on this 0stl: __