Swinton, Paul L O Y N OF QUEEN,5BU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 4zj-
Name /�/9�� 54J / N 7—d/-V Case #T02
Date of Cremation C - 7 - "�'- .1
Time Cremation Started 9� �� /I!/A t
Time Cremation Completed L 191 M �
Type of Container e-+cdr v,TJ,G/95,F oFrh6Fr��
Remarks :
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FWM M.B.i`,ILMER FUNERAL HOME cqy NO. Feb. 03 2001 12:30PM Pl
r��WN C)F C7'vEEN:iB'JRl
J Evv CEM5TEPY
CRz-VATORIUm
Quaker Road_ Ouee^sou-/ NOW YCrk 12804
Phone(518)Crema,oriurn 7 45.4477 (if no a^svren vl
Cemetery 745.44 i 6
AUTHOR;7LA7I0N TO CREMATE
The undersigned requests and authonzes Pine view Crematorium. in accordance with and subject
to it utes and Regurations to cremate the remains of
►" a�) / f (SEX)
(NAME—) -7e
Q r4axJ � �, c� !� N.
;STREET) (Cl1Y) (STAY (ZIP CODE)
who dies on .._—day or
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20
CA/Z-
at
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of persor,.auAhCr zingcrem ion:
tkJ
Relationship to deceased /
Name of Funeral Home
IN"RTANY r n pacema r in his or her
I represent that to the best of my knowledge,the deceased h$$o
body. 1CIRCLE ONE)
e Cr8m, 81iOn of the
l certify that i have the full power and ced remains, that any personathormation to arrange for 1possessio s have remains her been
to direct the disposition of the crew and save harmless
removed or mey De destroyed.n ano a��deto mands for of damages which mazy be made
Crematorium from y remain
ag them y reasons f oeroconnectced with the crerrmtionf of alsesaid
f eudule as directed,who their
8 � !arms °� �
THE S {ADDRESS)
✓ Alt ATIVE OR LEGAL REP p•Nd ADDRESS) � `�'1c� j �l-
{S NATURE O�Eu � a0d� I �- �?p
Signed on this date'