Ives, Ethel rl-nWN OF QUEEVBU9 Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name ���� 3 Case # 3 3 a
Date of Cremation Q / Ll — L'(
Time Cremation Started 2 V, ✓1-n
Time Cremation Completed 2 lVA
Type of Container OPT DOV41z") 44„¢�
Remarks :
FROM SOURCE ONE SOULUTIONS INC FAX NO, : 5183728107 Ju 14 2M4 10:02AM P1
Tom of Queensbury
Pine View Cemetery
Crematorium
Quaker Road, QueenW)W, Now York 12004
phone ma)Crmmatodum 7454477(it no answer)
Cemetery 7454476
AUTHORIZATION TO CREMATE
The undsrsWwd rogwev end yuvoft"Piro Vlow Cromat"kim.in aoeor msm wilt+Ana ri
to its Rulm and Regulations to OvrnaN the remains of:
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vAw died on_ 4Q4f' -airn►of �"u.l
Me"and address of nearest ilving relative or name of pstson authorizing c r
y 'T.
R�rlattiawhip to do 4osW
None of Fund Nome BREWER FUNERAL HOME, INC.
IMPORTANT in his or her body to ONE)
I wft t ow to ow best a myw decee.ed>
i o.r*that I here fw DWW 80 ibOA to S roW"rft"Mom d d»+arrrims ens to dimathe
of trw etemated ra n*w,that ant►pe"W MWSWAe have either bsert Wood or may be dastr .and
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Witness Add
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