Frazier, Maurice TOWN OF Q UEENS B UR Y
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, NY. 12804-5902
(518) 745-4476 (5 18) 74 5-44 77
hitp://w%vw,queensbury.net
Funeral Director: ����D N C fl Gko Mo
Name of Deceased: AU 1` i C 1 -e
Case Number: 7 �, r
Date of Cremation: ^ o�
Retort: T F,
Time Cremation Started: 6,1 30
Time Cremation Completed: !/ fl, qel /gym
Type of Container: C >Q%A-e
Remarks:
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Nome of Nnturnl Beauty ... A Cood Plnce to Live "
G�/L�/LGG7 li:Ly 51�3--b`Jb--1143 BREWER FUNERAL PAGE 01 n
Town of Queensbury
Ack Pine View Cemetery
S
Crematorium
UJ� Quaker Rood, Queensbury, New York 12804
phone(518)Crematorium 745-4477(if no arow)
Cernvtery 7464476
AUTHORIZATION TO CREMATE
The ur4ar&%pW roqu M and authvrim Pine View Crematorium, In soewdanoe with and subject
to its Rules and Regulations to cremat*the remains of:
Now s«
strut cry Zip
who died on 0'�3 day of �c/�,,rQ_ 20 Z lS�^
Addrou
Place
at Ly� j:]E-
Name and addraw of nsarest living relative or name of person authorizing cremation
.00
Reiationship to deosa®ed
Nwm of Funeral Home
IMPORTANT
I n mw%#*to to but of my knoWndP.the dweaad!!lllt or h 00 WON!WW in his or her body(CIRCAI ONE)
I oeRtfy V*t haw%N paw and autri WAlion 10 WOW fOr the WWIWon of the rs uft end to dIMd to diepostion /
of the CpOMMW ran►&*,Ow wV pantonel pouaszkM►lava arhar bean removed a may be dueoyed,and VW
to p imi n g defend and sere ha{f om Pins View Crrnnkm w from any and er omkns and demanos for loss or 40r+0 s or dw*
qpe nr a mess apelm them by rasa+of or oonrndad wMh ttw cremation or said mnmW s as dosod,whether ad,
danerm are or ass net wh*gwrx lus,fakes or*KWU ant.
37
MCA
�n Address '
(SIGNATURE OF LATIVE OR LEGAL REPRESENTITIVE)
signed on this
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