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Jones, Neva (rO ltiN OF QUEEVBW�.y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director -BUf? Name 1.1EVP M ZoLjES Case# 12 n Date Of Cremation 2o10 Time Cremation Started 0 3,'_ A !111 Time Cremation Completed -1✓I Type of ContainerOL-P \' P P-6) MWN ' l� ►�� Remarks (�Q V4 wTr)I-ZD C pt'r'A�7_ A /,,-i 1 t la -3oti�� i i FROM ALEXANDER FUNERAL HOMES PHONE NO. 5196232065 Jan. 29 2003 10:59AM P2 130 TOWN; �. SBURY " •PtNE'V( CE� e�RY CR TORIUM` Qua"r Road,Qu"Asbury,New York 12804 Phonp.(518j.C�Ce 7 .. 6 (►f rip answer) AUTHORfZATION TO CREMATE The undersigned requests and authorizes Pine,View'Crematorium.in accordance with and subject to its Rules and Regulations to cremate the. ,re�cr�a►ns of: NEVA M. JONES Female (NAME) (SEX) 133 Lawrence Street Saratoga Springs. NY 1 (STREET) (CLTY} (STATE)• (ZIP CODE) who died on the 5th day-of March 20 03 _ at Her Home on 133 Lawrence St ­AP_t-, 37 Saratoga866 (Pt AUE) (ADDRESS) Name and address of n0srest-tiving relative or-name-of person authorizing cremation: GLORIA J. OONES',�: 116 �T�i�or Lane; ,Camillus, NY 13031 Relationship to deceased,•$T,S t e,r i n 71`a w Name of Funeral Home Buranich Funeral Home, Inc. 5431 West Genesee St, 1 0illus, NY 31 IMPORTANT I represent that to the best of my knowledge;the decease&W,""$s no Pacemaker in NM her body. (CIRCLE ONE) I certify that I have the full powsr•;aad,authoriatioa,to arrange.for the cremation of the remains and to direct the dispWittat�Rfi �= i . Y:R ,f? $have either been "" ti' harim*bs Pine View removed or may Iw:.,doyeci;�agKrepto- edaddeid Crematorium from any aril ail datipK and derriarid$for foss or s which may be made against them by reason of or connected with the cremation of said remains as directed,whether such claims or demands are of etwhot wholly:'.groundiess,faise•or.fraudulent. _ S � -03/ U 6CNe6,e 5� C4*,'11QS� NY 13031 TNESS) (ADDRESS): ✓,, 110 r'110 aR LN. 60rays, NY i3©3 (SI(;NATtlRE OF RELATIVE OR LEGAL.REP.AND ADDRESS) Signed on this date: f! 3