Marshall, Milton f
TOT�N OF QUEEN
,s5 B U P�y
PINE VIEW CEMETERY ANI) CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
J� 2
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v
�a : e OF Cremation
Cremation Started
: .e Cremation Completed AA
. ' pe of Container V-r>g3 A0
J c IPlk
�_�arks
nwty C)F tJ11L't �SCtUNY
i'' UL Vlt;W CCA ETE RY
6
CREMA rUn M
Ovsker Road. Uv eertnbury Npw York 12804
f'Iwnur(7►18)Crerrnetoriufn 74, 4477(if no answer)
C-Ormlery 74!3 1476
WHORIZATION To CREMATIi
,'heundersigned rs turd equ0sl.s and authonzes pkre View C en>$tgtlutn. in a�cctrrdan a with and
bufl)P.r;t
io Its Rule RaUulabons to mmale the rernolns of
F ha
(SEX)
F<0xk?urY, Conn .,�
t i.(, u t. 06783
(CITY), (S1ATt) ,.. ..,.
who died on o r h
(fay of ,-•,.,,,`► '1,�...._.,.,... ,,_ � 04
_ _ .t)....... -
at wee<1 f f—f�x:'c'�»»'`M r a.f. i e 1 d 1 �7
(�'tAGCj `sd, T.ir.c,rt(ikAr:0(44# Ne_w York,
Nampa and ectdres8 of nearost wving re
laHva of rramti vt t t5or►truthcwirlrtig cretnatk�n.
Le n 31 R�ci ewc�ucf ti� Woodbury. CT Ott`!
98
110WOonshlP to deceased d a ki q h t f.,r
Name of Funeral bane Wilcox & Rey ,rrt r«r. ara 1 home
IMPORTANT
I eISM that to the beef of"krtawtsdgs, the deceast 9
body.• 19CLE ONE) t> o Pacemaker in lo,%or Iter
1 vertlfy that 1 have the U imer end euUK*Zation to afrr
IQ dlrsct the di"s"Jon of go mad/ems, that air V9!or the cremation of ore ftrmains and
reipvved or rnsy bet! and a0rew iv y Of t possos 10"s have elllter Welt
Oiw- natorium bath PrOlOc, dsk DOW ti m harmless Pine View
trpeik�sl them aM t drtte stxf d ftds for bt or Ahvmpes which may be made
such Claims t demo mid arre or tdye the mallo vl tad rer+�►atins 00 dbected,whelher
y 9 ndlese, also or fraudulent.
(WITN�CSj�� (ADDRESS) ,�,._._ ..-.�..�..�.�.....- ,L
(WNATURE OF RPAATIY R L GiAt- REp. AI OADDRt SS)
Signed on fhb date: ,, .