Velez, Felix J
2-0q+N OF QUEEVBUNY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director '1/I /L All
Name / �%� �/- / Case
/ `/
Date of Cremation /
Time Cremation Started
Time Cremation Completed
;7.'7 .�
Type of Container
Remarks :
02/18i99 THIT 16;27 }AY 518 483 8411 '120 i?1R1: 11I11 CUk NC
I L. t U '_+ ; °,-# 'x m >+ VI III #U1-I '� __-+u F . u 1
TOWN OF QUEENS9URY
PINE ViEM CEMETERY
CREMATORIUM
Quarter pond. akleensbury, New York 12604
ph4na (9te) Crematorium 745-4477 or if no answer
Cemetery 74Z-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authoraies pine View Crematorium, in
accordance with and subject to its Rules and Regulations to
cremate the remains of:
Felix Velez Male
(S eat ) (City) - (State) ( Zip Code )1,2-9S'3
who died on 16 day of February 19 99"
ar Albany Medical Center _ -
(Dlaee) (Address)
)'lame and address of nearest living relative or nose of person
auLhorizan Cr"emat,o^ �
(Nasf� (Addy s)
eeeasfd Lo- G�,`it(
flolationshao to the d r
man* of Funeral Home A14JJg65.fjC � ----/
l l�)ORTAHT
I repro sent that to the best of my Knowledge, the deceased has or
has no paevmal»er in has or her body. (Circle One)
I Certify that I have the full poser and authorization to arrange
for the cremation of the remains and to direct the disposition of
the cremated reaaans, that any personal possessions have either
been removed or may ov destroyed, and agree to protect, defend
and save harmless pine Vivo* Crematorium from any and all elaiss
and demands for loss or d es which may pe made against them by
reason of or connected wit the cremation of said remain* as
directed, other sue 1_a as or demands are or are not wholly
groundless false ent.
(fal vas, (Address)
lgnature of Relate a or�Legal Rep. end Address)
armed on this dates