Jensen, Muriel TORN OF QUEEVB U9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director � r 1� j//
Name 14 Q /c���1/�/YS�fX Case # j2g
Date of Cremation
Time Cremation Started to &M r
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Time Cremation Completed /g fN
Type of Container wit/ / �1 ��/�/ ' /Y��G/}��O/c7—h�l�/�
Remarks :
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APR 24 2000 09 : 31 FR TO 18022654256 P .01i02
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Sent By: Ourtee Funeral Home; 802 285 4256; APP-23.00 4:27PM; Page 2/3
TOMM OF QUMEBURY
P"R YMAW.C1 QII1r`t .Y•. .,.
CREMATORIUM
CW W Road.QWKW u ryV.New YbrK 1260.
1�fliors►(5t1�Cremitvrlm 74544"(it 664wlRwiry .'
Cam"746.4476
AVTWORM41ON TO CREMATE
The underalpad ragwsle and sulhorizes Pine View Cramatorlum,in 4oeeidenee Mdth and su Od
to Its Rubl we o RaphWons b4mmaw the-or. no,
N1ra. Martel Jensen,
(NAME) (sex)
12Z Colle e 5 Pou I tkicyj 057.64
(STREET) ( (STATE) (ZIP COW
who died an 23 r tl. day al A' 1. 2aQ,Q
at > � �e>tidence; ' 12�' Col tege► 5t. fitf: aip � V
(PLACE) (ADOR EIS)
Q di W "M Ww PO"ipue �Ner>ne>8hd eddreii � 1' o,r nerve od ciletrfAfbri;
Pkt'. '
: .St. Luc
� �Y;: 8etret,�'' 3'yGP'Aatcpvra a Cowl '�I�p 'i8�i, Ft�rida. 34952
Rc>>j1i+,ttiehip�d��� ...' ae11g1►tdr :. ; . . , .I
l
Nertte of Fut�ai,Pl Haute terte-Aupin FueTlt� . poultne7. Vt. 05764
Ilw"rAn1T.
1 repr666M that to Ala but df1 my kttt�liirledye,ttNi t(fidaiMd,p in his her
body (CIRCLE ONE)
1 :ihr �w:? Agit tr?,aRit! 'ibr It�ir a�'f of ltt d8rrrnw+e and
tb dWW =1801A i ot -ih 1nR d' peON+lY� been
rernmd or MW be d ,and ba pro4ect,dtlterlCf lli ss'�merle
� 111orlum t+a�m�'.jr�.doVo atnd kr.lp�Qr �Ydt tne�
ig�rlst oiatrr t>►y rltttlidrt tlf our ConMlei�1+D,rtn�rree�6ltfer+ ��� 'sd`
suety elrime or den ends We or en not WHY g,MM lies;aitii otTieiifdtiwrrt
NES.•;. ` 00 e,4
+. Er r-z-
UR RELATIVE- E L ff -AN �`T�
S19"W on thle deer: Apr! 1 . 23, 2000_