Armstrong, William rrO WN OF QUEENs5BU-' �
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director liSl14:-
Name i�(,�.l�� -����/�ase # a 70
Date of Cremation �` om oZ
Time Cremation Started :2i1
g:cAl m
Time Cremation Comoleted 191M I
Type of Containerz"71492& -y IQ/V171 IIZIA5�5- C/C`.. ! Akc.7- /
Remarks :
gi�y� /A )
+' TOWN OF QUEENSBURY
PINE VIEW CEMETERY
&
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 (if no answer)
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in accordance with ar, subject
to its Rules and Regulations to cremate the remains of:
(NAME)
(SEX) —'--
c(
(STREET) �(CTY)
�(STAT�E �tP4?�E)
rho died on Ci * day of
�t
(PLACE) �A�DDRE�S )
:ame and address of nearest living relative or name of person authorizing cremation
Felacionship to deceased
^:ame of Funeral Home BREWER FUNERAL ROME, INC.
IMPORTANT
represent that to the best of my knowledge, the deceased has,Dcdy (CIRCLE ONE) as no acemaker in his c ner
I certify that I have the full power and authorization to arrange for the cremation of the remar 3rd
to direct the disposition of the cremated remains, that any personal possessions have either : en
removed or may be destroyed, and agree to protect, defend and save harmless Pine View
Crematorium from any and all claims and demands for loss or damages which may be made
against them by reason of or connected with the cremation of said remains as directed, whett
such claims or de�na ds ar or r not whplly roundle s, false or fraudulent.
(WITN S (A RESS)
(SIGNA URE OF RELA IVE OR LEGAL RE SS)
Sigreo on this date: /ol ')