Andersson, Rhianna rrO`Tii N OF QUEEVBU9 Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director �j,���
Name g lyl yfi 4&P—,�/��se Case # /
Date of Cremation / ��j— 67�/
Time Cremation Started /cZZe 9!j' r" 1
Time Cremation Completed /'!'/( M ►'
Type of Container Gff7�f�f�/�.17
Remarks :
/v�CC
J.re c1!! qll lasAlS f t< !.t'. MAf:'�' .. GtW^C s✓E41 G�tl bAi: P`.Of
r
Pits VILV CEMRTIERY
00*kor Allan, Ouonnobur•y, NOw York 11604 j
Phone (OIA) Cr'eaatorlWa 743-A4?7 or if no answer '
fs■ott err 74tl-4w7a
MTH0111IRTION TO tCRIM TC
The undRrsioned roauos}s ltha autHlirizes Vigo VitM Crematorium. in
aCcordence *+ith and subject to its Itulms and AebuJat�ons to
crtmdtt the rsaatnt set
Lin noll
tk�loo) t6oM) �
d�a d8
<gt-eet) (city) (state) (2io COO*)
who died on d&V Of An
at { n
t!1•co) 11'Wdrees! ��
i
Nawo and addr-ess of noorsst living rolwtive or nsoo ati po�avn
artherittd�S C1'ewstfonf �
(No
i
�k
■e) t dr ss)
ti
Its 1 et t owsh 1 a to the
fdaaR Of FVItRfal Hpae
!l�ORTiiKT t �
3 rm at t• the best •! Aji lkttab.l*dle, the deaoas/d has •.-
naa 0 pstC1111aN11 in his or her bttdy. IGircle Dne)
1 c»rt i fy the* t hwwe t{ti full ii4or and authori mat ion t 4 arranSo
for the t:roeation of the remains at+d to direct the diipoiition of
the cremated ropainss th&t #ny perse"&l possessions ha a either
been reseved or sate be "d�st•roved Wand a roo to prttsc defene
and $Ave haroleea pine View Crenatoriue IV-04 6"Y ane *;A ales•*
and dooands for lost tr •d4vapvs which may be made agat"*4 them ay
roasan of or connected with the c.oew«lion of said r;swine as
diroeted. wMetRer such claim$ Or dowwpdo are or are n{t whets)
groundless$ �tfalse or, fro dultt+t.
{ilithlssl t►7VVt^est)
tlignature of Roloti o ve Loga . slop. and Andress)
Signed on this dater
I
i
Tn aCMA "ldNgI Nhli Aqm-AAA Pb)7--WA--ATC ?G :TT TlL707.CCl/Ttl