Merchant, Vera L OWN
OF QUEEM 1J l.,ll�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ,6�j
Name � ' ?AJ1�1 �/�1 [[! � Case # �6
Date of Cremation /0 a7 -- a000
Time Cremation Started L/,' � /'M P
Time Cremation Completed Jt'r q<�
Type of Container
Remarks :
4J Z12 e
Al
. _. . . ___._- ------------
19i25f2000 19;00 51S--69E•-2743 BREwER FUNERAL PAGE e1
I TOWN OF OUEENSSURY
Ptwa VIEW CEMBTli fity
b
CREMATORIUM
Quaker Road,OuasnOwy,Now York 12804
Phone(516)Crermitorium f.A"477(it no answer)
Gamtetery 74e44�e
AUTHORIZATION TO CREMATE
Tne Wind nee requests and authorities Pine Vlew Cnmatarium,in accordance with and subject
to its Ru'i.and Requladons to cremate tttS Tema la of,
Iz-r�c.
(NAME) (SEA)
(C ) (STATE) (ZIP CODE)
( LACE) o ! µ
t r-;
Name anp addr"S 01 near*$%HVIMg telatWa or neme•Of person autnoruiny c an��liv
re
Ralstion hip to deceased •rr
Name of unerat Home I
r
IMPORT NT h acemakef in his or 04r 1 s s Q
ropmea N1 that to the best of fny knowledge,the 131111011168410 jlilt
body (CIRCLE QNE)
n nye for lne oraRuatwn V the rel—alo-Pnd,i i l
I oeniry that t t'+aw the r,ill rsOWar■ntl auttwntwe `� ereenai eeeee.�����>.�ara either tfe0^
w diret& a rlisnobl"n oT the Gretna TN til tyre'thrt any P Wave poet a0*,j'eie Fino
remove Or may*a �fjEtyed,and� tsct.defend end
GramatohuRt from any i-At1�daltna end d hitOinda for Wsa ur damages which may"made
4 ;;.ra; J t�n
a9elntt t�iWM by resodn tN Or z9nf cw*0��fewn of aald remains es dirrcted. t nattier, .
1 undlNs hiss r ha, lent• s . rt j i
such c t or �a a are an js/'ti
N RES MIJ
WITH S '' ( �-
v ReIA cores GAI- FWD°^����R Mvog icrA to
n s}n this date a~
q1d 3fy -2431-