Ramsey, Edward TOWN OF QUEENSBURY
Pine View Cemetery nud Creiuntorhim
21 Qunker Road, Queenshury, NY. 12804-5902
(518) 745-4476 (518) 745-4477
hIrp//w%vw.queensbury.net
Funeral Director: "rJC.L4--4-G-j
Name of Deceased: au9►a-1�-r� P,�I��S�K
Case Number: 3 2S—
Date of Cremation:
Retort: �' C
Time Cremation Started: 1 (9 S
Time Cremation Completed: 3
Type of Container: _(Z,44rXcA%,o�-! ) A4_jAr;bI j (J�•�
Remarks:
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" Hong of Nnturnl Benuty ... A Cood PInre to Live "
TOWN OF QUEENSBURY �Z
• PINE VIEW CEMETERY&CREMATORIUM
Quaker Road, Queensbury, New York, 12804
Phone(518) Crematorium 745-4477 of no answer Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in Accordance with and subject to its
Rules and Regulations to Cremate the remains of:
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(Name) (Sex)
15 Y,r"a^YYJ�i.� �VC.. l �cr Ya12lf7 4 p v�
(Street) (City) (State) (zip)
who died on 9 day of �_� J), 20 0,S-
150
at - -� 4-4r�l � AJ N_
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(Place) (Address)
Name and address of nearest relative or name of person Authorizing cremation:
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(Name) (Address)
Relationship to the deceased 5CYY7
Name of Funeral Home - o. - 1
IMPORTANT:
I'represent that to the best of my knowledge, the deceased has o has no pacemaker in his or her body.
(Circle One)
I certify that I have the full power and authorization to arrange For the cretion of the remains and to
direct the disposition of the cremated remains, that any personal possessions have ether been removed
or may be destroyed, and agree to protect, defend and save harmless Pine View Crematorium from any
and all claims and demands for loss or damages which may be made against them by reason of or
connected with the cremation f said remains as directed, whether such claims or demands are or are not
wholly groundless, false or rau ulent.
(Witnes (Address)
(Si atur of Relative or Legal Ref. and Address))
Signed on this date: _ u.
X
TOWN OF QUEENSBURY
CERTIFICATION OF CREMATION
PINE VIEW CEMETERY & CREMATORY
This certifies that the remains of: EDWARD J RAMS8Y
were cremated on AUGUST 1 120 0 5 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains
of said body.
Date of Death jay t 2 8 ,2005 Ago 81
(Month) (Day)
Funeral Home SINGLETON HEALY Registered No.: 328
(Authoriz ignature)
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COPY
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