Beaulien, Muriel 1
i
TOWN OF Q UEENS B UR Y
Piste Vietu Cemetery and Crematorium
27 Qunker Road, Queensbury, NY. 72804.5902
(518) 74 5-44 76 (518) 745.4477
http://ww%v.queensbury.net
Funeral Director: �✓l��— `� t
Name of Deceased:
Case Number:
Date of Cremation:
Retort:
Time Cremation Started: Ste. for
Time Cremation Completed: , -5
Type of Container:r-446-��-) eeg4 J L -z-0
Remarks:
M
1�7 Z A/
" Houle of Natural Beauty ... A Cootl Place to Live "
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• `" Town of Queensbury
Pine View Cemetery
Crematorium
Quaker Road, Queensbury, New York 12804
phone(518)Crematorium 745-4477(if 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:
Mu.r i e I �e a.ud Ie.rN L c i a)�,
Name Sex
OD Sn al 0-�kjd &rad-p2a 5 r" ti (o(o
Street J City a J zip
who died on �� day of 20D_
at C_k
place Addressaj
Name and address of nearest living relative or name of person authorizing cremation
O'�� ekcLllIIPram .
Relationship to deceased
Name of Funeral Home BREWER FUNERAL HOME, INC.
IMPORTANT '
I represent that to the best of my knowledge,the deceased has or has no pacemaker in his or her body(CIRdE ONE)
I certify that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition R
of the cremated remains,that any personal possessions have ether been removed or may be destroyed,an#agree
View to protect,defend and save harmless Pine Crematorium from any and all claims and demands for loss.or damap s or dam-
ages which m;a made against them by reason of or connected with the cremation of said remains as directed,.whet a ed,
whete5ucaims or demands are or are not wholly groundless,false or fraudulent.
M
it Address
r
!(
Y NATURE OF RELATIVE OR LEGAL REPRESENTITIVE)
signed on this date 25 o5