Leyro, Juan f7-0WN OF QUEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name LV D Case# 1� 0
Date Of Cremation Zl - 1 _ 2.00 3
Time Cremation Started
Time Cremation Completed
Type of Container QaV4l,2--o
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TODCi E. P®i_LUTRO (: .
NOTARY PUB.LIO � Notary Public
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04/09/2003 13..30 518-639-4486-3299 WASHINGTON CORR FAC PAGE 02/03
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