Anders, Johanna V
2O`V N OF QUEEN4,5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
DA Funeral Director &a X17?E
Name cl�'J17-17NAACase # 13 a
Date of Cremation g-1— a6ce
Time Cremation Started Lsod to ,,
Time Cremation Completed If R/IM
Type of Container 7-") �i9�
Remarks : ���� /
1 )N) �
z '/0'A
i
i
i
i
-J UL acts—tob 107 GZ30 N1'1 III ULL C1G be 1.lu LLCIC ...ao voe Gov �+�
i
I
� '�R,�� r!..E>;=#JI�FP. FLI IiRRL �19�= F�t•iE �111. c,�73���•5 :u l. 11 3N'�C� 1�:'�f'• ��'
TOWN OF QUEENOBURY
PINE VIEW CEMETERY
8
CR$N'uaTORi ili<4 ���
QvSkor oaao.C.ue,arsbLry,New Yo-k 12604
Phone{51&)Greme:or��rm 745-4477(If no snswer)
Cnrrletery 746-4476
AUTHORIZATION TO CR---MATE
3
'T he vredsrssyned me 'Gst$014 authorizes P;no Vow C-rematcrurr.,in.ac:corda'tce mth and 5ubiGct
Luis Ruses.and Regu'aticns to cremate tare rtme,ns of:
Jottarn:T Anr'.n-s Feanule _
Bar
ionr_. rie At=s. u
_ - Ceen ew York Z + _. ..-
tRTR`'Ety (CITY) (STATE) (ZIP CDf3E.)
7th _ �uiy 20
a day o4 ----
wno dl..a on , , _ . Y ,
at Glans Fall Y.Losy ta: Perk St. Glans ^ails, New York 12LZCII --
N*me aril address of ntaresl living relative or name of perscn a,jthor;zing cremation
Mrs, ^.hr i ssine Johr satt i_
Rslat;onst,lr to decwFed AdtYrinietzat rvt
Name cf Funeral 4omc Alexander Funeral Fame —
IMPORTANT
I reareserr,that To the bast of-ry 'tnovv400ge,the deoeased=or has r0 p=0M0er!n aam nor
body. (CIRCLE CNE)
I eerufy ji,ssAt Is have the fu.i ;Cwer and euthorizaticn to arrange far the_rematk,m c'f tF.e re+rulin$n�d
to direct the disposition of the cremated remains, that any per'sana!poseesstors have anther t;ewri
rerno;+�4 or may t*dastroyed, and agree to protect,defend and save harmless Pins View
Cr*rnat9r,wrn from ony and 40 claims and dernarfds for loss o,-damages which Tray be -Wade
aga,nst them r,y real;-, of or zonnecfed with the cremation of said remains a$dlrectcd.whetne
such claims or dernw,de wrc or are not wr,olly Qrouh41e6a,fate or fraUdulOnt
(ADDRESS)
t_ne .1. Jo}msor), 12 wing st nle:;s fq'ls. 2601
(Si GNA,7URE OF ELAMNIE OR LEGAL.Rt_P.AND ACORESS)
Siynea on this date:& ILkL _
G