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
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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
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Mar0i 99
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who dlea %3n �-
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living rtlativq or n&MV of orrson
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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.
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