Coffey, John �o OF QUEEVBU-WY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name XOUI , 'E Case # 3 IA- C)
Date of Cremation rl — 23 - L\
Time Cremation Started ��j [�� �✓�
Time Cremation Completed
Type of Container CV4--Q-0) AA w1 10
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07/22/2004 15:13 1-203-438-5068 COFFEY REALTORS INC PAGE 02
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