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Hall, Richard 70 4� QUEEN5B U RY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director Name Case # Date of Crematicn •�� � r� Time Cremation Started- Ti me Cremation CompletedA- Type of Container �' ,�;'It'l�l ' o7`j_l� ,hl�l�, C-✓7'r �/ 7�f L%�y� Remarks ; HAR-11 199 13:59 FROM:H�-ISHIN(3TOH CORR.FAC. 51e-G39-4073 TO:518 4942948 PAGE:01 MAR- 11-99 02 : 19 PM BARTON PICDERMOTT TOM CW GUlgENNSU'Ry Volvo aiA rveay0ek QuoWVr Ragd$ QUO* If no aniwor phone injja) Cromat0r- t ,Iq 749- 477 Or Cgootery 7454-4476 PUTHORIZ14TJIQN TO URF.MTF- and &uthorixes Pine yi" Cro" ""t14' The undorsigned requests and 10 s and Rogul6ttOns to accordance WLtM and Vqo)vct to %to crVAat* the aft Rlil,'MARD HALI, Memo LockCf),11s tock NY Lock 1.1 R.d -------- ; Z i Cod %V ) (City) k ;6T. WFp Mar0i 99 801 a V d f who dlea %3n �- GLENS FAILS jj0SPLTAL PARK at� P­ F49310 I'm I s (Place) living rtlativq or n&MV of orrson "age and address Of 6..r M S K NY PATR:CCK RYAN *WASHIN(,TC)N (IORREMI(j) ,\L. FAC LL1'rY -,.... --W ----I SLjj,KRjN'j'ENj)ENT ADMI.NT.STRATION jo to the dvcv#09d rave Ct4C,CHE1STEji:r0WN,NY Name of Funeral Hoof BARTON--tM(.:j)ERMC'TT Flj�IERAL JI(ME 00001TA"M a to the best Of sy knuval4d9w, the dwC96990 has Or va9prVIOnt tM&t (Circiv final he$ no pacemaker tM "is or- net, body. WprtAfV that I have the full power and a4thQri8&" OM to arrange the rVesins and to direCt the diSPOSMOM Of for the crws*StDn Of rsonal pq%6*oqians have eiipwor tne Cromatod rem IMS, that any pe 0 to protect. dIfy"d :.*y be destroyed, and agree been rb@6%vgd Or Pine vitw CrImAtOOi4s from any and all cl&iGs and save M*rvl*ss maggs which way be *ad* 69airst them by and dwas"d$ for 104% or da With the cremation of va4d remains of reason of or CannoCtyd dwea"4* are of- al-a not -WIV dirictadq whgtmwr SuCM q101" or }fall fv-Svoulwnt. CW� a I- 't 1ST(icK,NY WASH INGTON (,'0RRFC'-.C10NAL FAC- 4 V— W tpddrvss) Ny WASHINGTON CORRECTIONAL FAC ComSTOCK, V 149p$ and AddrWVS) b. i A a a a