Burns, Peter SOWN OF QUEEVBU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Directorlv� 13 v t
Name L) S Case #
Date of Cremation l — q --� 0 c7
Time Cremation Started J 'J tiles p iV
Time Cremation Completed
Type of Container oKaD (36r4ad �2 5--6
Remarks :
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TOWN OF QUEENSBURY I
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 and subject .
to its Rules and Regulations to cremate the remains of:
Peter J. Burns Malt--
(NAME) (SEX)
33 Sheridan St Glens Fal1c my 110ni
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 17th day of July 20D,d
at Glens Falls Hospital Glens Falls, NY
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Pamela Burns 33 Sheridan St., Glens Falls NY 12801
Relationship to deceased wife
Name of Funeral Home M.B. Kilmer Funeral Home
IMPORTANT
I represent that to the best of my knowledge, the deceased has has no acemaker in his or her
body. (CIRCLE ONE)
I certify that I have the full power and authorization to arrange for the cremation of the remains and
to direct the disposition of the cremated remains, that any personal possessions have either been
removed or may be destroyed, and agree to protect, defend and save harmless Pine View
Crematorium from any and all claims end demands for loss or damages which may be made
against.ttlem by reason of or conn"d with the cremation of said remains as directed, whether
such`clalms or demand not wholly groundless, false or fraudulent.
s r or a,e
V�ATNESS) (ADD ESS)
�It"26. -fi-��,
(SIGNATURE OF RELATIVE OR LEGAL REP. AND DDRE )
Signed on this date: O