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Christie, Jessie rrnWN OF QUEEVBUNY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director��2, �� �(U o 12 Name:.,F-S,� \� E l,,/rl}� Q ' Case# 2>6 Date Of Cremation Time Cremation Started ea �� Time Cremation Completed -{- Type of Container Remarks v Ll 01/18/2003 10:02 5169217861 CHRTSTIE PA '— GE 02 S F" ALE)iAt401W i`IMIEFtAL H-M15 P riQ. sess ` ran. 18 2eM 1'2:s" P3 TOWN,. RY If�t Y Wbil rry RLIM . Phan f� .Yprk 128Q4 3wr . 'Y. so AU' 'TOQRCMATE The undersigned requaa,'i d C�irtrtait6riunl, a aaardan to itir Rules,and Rspule `�, � y lt cs with anq swb►sct 3eesfie S. Christie ; Fetnal® 1563 BeaVeir Gam Creek Rd. , Crozier, % 23039 who aced on 17t1�. . yy,a,,.ry,.��. •:�:u' 3 at Adirondack 'i`ri- oU.01 .UNl;th re �er, North Creek, NY (PLACE) Norm and oddress•of nesaCagrt•Iiving reiativO er,r 0 te,af person authorising asmotion W. Robert Christie Clri ' 9pxit lttkk:Lstie;`Syosset, Ny 11791 Relationship to Name of Punerai Moms Alexwdar Funerg1 1'lMN Jnc•.; Wslrrensbu! , 14Y IMPORTANT I repnsaent that to the b"t of My knawiedge;the deceasad hoar'has no pac maker ill his Or tier body, (CIRCLE ONE) I eerily that I have the fuN po"rand.wthQf# goit t©arrange tOr th'e.Crernation of the rernains Ono to dhect the dip* removed or may ba .., 'rt!!nY; ,pnrattona have eider been Crematorium from ar,y " N and,ef' Ltd ttgcmieide Pir1e view t0i'tou ar' ys which may be made agatrtet rea ri qt or conn$ated Wid1"th!t.rerfgftion of=aid raritains see directed, whether a mn or demands sn pr am not.whoNy greundMee,f&Ww:or houdulent. Warretsabur g, NY Si w as',obove (SWINATURF OFMATIVE OR L84AL REP, 0 A0ORS93) Signed on this date; I' I Y—a.4