Loading...
Whitty, Brent TOWN OF QUEENSBURY Pine View Cemetery nnA CreinntorlUM 21 Qunker Road, Queensbury, NY. 72804.5902 (518) 745.4476 (518) 745.4477 htrp.//w\v\v queensbury net Funeral Director: Name of Deceased: Case Number: Date of Cremation: ' �j 2 — Z 03�,5, Retort: T �Time Cremation Started: Time Cremation Completed: Type of Container: a4lja 1-6/V . Remarks: i " Home o/ Nnturnt Benuty ... A Good Pinie to Live " 03/29/2005 10:24 5185854475 WILCOX REGAN PAGE 01 TOYYN OF QUCCNSOURY 3 Sr PINE VIEW CEMETE11Y CREMATORIUM Quaker Road.Queensbury- NeW York 12004 PIvx*(518)Cremalorfum4 -4477(if no answer) Cemetery 76 AUTHORIZATION TO CItCMATG The undersigned requests and suUtvrizes Pirie View Grematorlum.in accordance with a1vJ subject to Ks Rules and Regulallons M gemgle the remains of: Brent Bevins WhittY Le ($�C) (�E) � � 1288 3 Ticonderoga, New York 112 The portage, STATE (ZIP CODC) (sTREEn � (CAM ( ) who died on 2 3rd day of march Z0 05 at Starr Farm Nursing Centex,. Burlington, Vermont (PLACE) (ADDRESS) Name and address of nearest hying miative or name of person auUt&kig cremation: Melissa W_ and f Canton New York Relationrj4p to deceased S i s ter Nam of Funeral H°m & Regan Funeral Home, 11 Algonkin St. Ticonderoga, New York IMPORTANT I represent that to Ute hest of my kl`001*10dge,Um deoeased hn Ore Pacemaker Ni his or her may. (CIRCLC ONE) i I certify Dial I have the tup power Old P � to direct a r@ 10 arrange for UIe cremalinn of Ute refnailts arid any pelsonal Possessions have Wier been r from W Slid NO dai m ra W aSM ro pMO4wW8 defend and save ham>less Pine View � m by reason of a< demalrlds for loss or damages whkh may be mad© sudt"fain"Vie or aortnected with Ute cremation of Bald mmalns as directed,whether des or are not WIK*guess,false or fraudulent, (WITNESS) (AbDR SS) (SIG E OF REI,ATIYE O LC AL RE AND ADDRESS) s ned i9 on Ihls date: ., 03/29/2005 10:27 5185854475 • WTL,COX REGAN PAGE 01 TOWN OF QUECNS[3UftY PINE VIEW CEMETERY 8 CREMATORIUM Quaker Road, Queensbury. New York 12t304 Pltorte(618)Cretnalodum 745-4477(II rw answei) Cemetery 746 44.70 AUTHOR17ATION TO CREMATE The undersigned requests and authorizes Pule View Crernatorlum. in accordance wills atxJ subject 10 its Rules ettd Regulations to cremate the remains of. Brent Bevins Whitty (N&W I i (SEX) 112 The Portage, Ticonderoga, New York 12883 tsTRE (c1T� (STATE) (zJP Cobs) wfp died on 23rd day of March 20 05 aL Starr Farm Nursing Center,, Burlington, Vermont (PLACE) (ADDRESS) Name end address of nearest Oft relapve or name of person autiiorizIrrg cremation: Melissa W. Brand, Canton, New York Relationship to deceased Sister Nam of FWteral Home wi leer & Re4an Funeral Home, 1 1 Algonkin St. Ticonderoga, New York IMPORTANT I represeM Vwt to the best of my krro'Medge,pre deceased IM or to pacemaker At I4s or her body. (CIRCLE ONE I co ft that I Have the hip power and authorizaUvn to arrange for Die crernaWn of Use reinains and to direct ilia disposition of pie oreniated►emalrts,that any Petsoctal possessions have either been re ed Or mat►be desV Od;and agree to pro194 defend and save harmless Pine View ) Odom from any Old all chins and demands for loss or damages witldi may Lie made against Viam tl►reason of Or co MG*d with @te rx+emallorr of Bald remains as directed,whether such claim's or demands are or are not vdiWy groundless,false or fraudulent. 0-- -": U . (WITNESS) (ADDRESS) wze-, I a r (sIGNKrURE OF REIA O LE Al REP(AND ADDRESS) Signed on this date: y?—a Q— C S �_