Bennett, Ruth f-yrz'-lrKN OF QUEEN5BU99y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director S l & 1,- -to
Name �V ! j�/U� Case #
Date of Cremation
Time Cremation Started
Time Cremation Completed J � /yA
Type of Container Jj)e)QC G( yt,��✓'}ylq ep �/(A`j
Remarks :
30
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12:(M8 99 10:31 FAX 6106883887 DBES AttornN`�yys CJO�
12i07i"i995 �!::y 51tl-%�J�-tl'Lbb �tFtV�l;t.C.l1h:F' :�� �...
ruw UF UMI NUBUity
pim VIED CEMTFEny
C REMia t OR f uM
pual�er Road, Out 0nsbury, Now York i2A�e
phone (518) Crematorium ?4b-4477 or iF n0 •hs►+e►'
Co•etery �4�-A476
pU'rMn 1 ZA-t I(]N TO VMMATE
The undoeligned reauryFs and avtheihitef pine View Crf"atc -ti++v in
accdr-dar►cV with and 'vbjvct to its Rules and "egulatton• to
cre00te the remains or$
--
tNaere)
A 1 01
t5krs:t) tCltsy) t5! !e) tZlp Codri)
C ii
who died on
at
ddy of 19
tD1ACe) tgddre 4 s►
Nswwe and adorers of „rarest livingn
r-elati" or name of .tpersn
60thuriring croMatsvnl
tNa�el lAddrass
Relt►tieinshlp to t)ve deevased
Naee of Fufrerwl )•ion•
JNpllq'/fin'r, 9 the dfctfosvd` hats or
t event that to tl,e best of my i,l+ewied ej
ata r palesadksr in his or her body.
1Circle One)
2 certify that ! Ivave ttve full power and autt"wrixatioh to Orrange
fbr the cremation a* thr remains and to dirvrc-t !fit diypnv1 either
et'
t1.at an eraonal possessions h•vs� eltt+er
tnr cr.waled rraai„a. Y A
been remeved or way be destroyed, and ague to prvt:eet,l defend
and save .harwleys P/ne
View Crsmotorive fret any and NJ claims
and de*•r?ds fur less or damage! whlm►+ mot be wade atialnst loins bY
as
►►emeon of or Cor,nrr'ed with the crewalil}n OI laid rOV whoins of
d PC! d, whether sveF rlaiw!• or demands ere or are nvt wholly
Q undi ess, lev o rr dul t, b
witness dr+►I'll�Esc
gignature of pwiative or Legal Rtrp- • Address)
signed on. this datet_�. D'
" 2/e7Ij9'39 97:,'3 518-793-0J
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