Brown, Elizabeth TOWN OF QUEENSBURY
Pine Virtu Cemetery nod Creotatoriom
21 Qunker Road, Queenshury, NY. 7 2804-5 902
(518) 745-4476 (5 18) 74 5-44 77
http://ww,v.queensbury.net
Funeral Director: /v1, C'-I-) 1= R. /VLO-T
Name of Deceased: )-rk �3 ¢---t+ 13 R d Le-) r\1
Case Number: �-ZC
Date of Cremation: - 2 q - 0 S—
Retort: _� �F"t—
Time Cremation Started: 6
Time Cremation Completed: d 44-
Type of Container: (7:/1A V-zr) d 4\7---t) ,L�. ✓�1, L) ! q
Remarks:
" Home of Naturnl Benitty ... A Coo l P I n c e to Live "
U01[zi/Zutio 1!:Lj 012i--byb--L!4 bKtWLK t'UNtKAL t'Alat
Tom of Queensbury
Pine View Cemetery
S
Crematorium
Quaker Road, Queen*ury, New York 12804
phone(518)Crematorium 745-4477(if no an wet)
Cemetery 746.4476
AUTHORIZATION TO CREMATE
The,undert MW requoeta and authorizes Pine View Crematorium,in aocordonoe with arrd WNW
to its Rules and Regulations to cremate the remains of:
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c Nanr � seat
cry slats zip Y/J�
who died on day of
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a e
at
Ph" AWN"
and address of rarest living relative or tine of person authorizing cremation
t 6- VA_aIan
RelatlonoMp to deosassd_,�
Name of Funeral Home
IMPORTANT
I MPIaartt ow to the bast of my kr►awMtdgs.tfie domm d ba or hno Pwwww to his Or hW body PRW ONE)
I o9rtify ttwt I ttarefUN P�and allthOrt AhM to arrange fOr tfw cremaaon of the rMdaNM and to dMeCt the daipotOw
of the CrI -w wi o,that any pwwW possowions have atMnr barn remand or may be daatroyed,and apnw
to pwe,1 darrr 'aid tars hwntl l vbow crwnakxun tram any and al cwams and damw oe for kxa or doffdo a ar dwYo-
n smash t iham of or oonrMW with Uw cramatloe of UW ra Wm m dkaoted,whattwa ad,
weir dd! MAtoMy false or twdww t. /7
witness
Cato
o
(SIGNATURE OF RELATIVE OR LEGAL REPRESENTITIVE)
si6ned on this date