Stuart, Julio TOWN OF QUEENSBURY
Pine Virtu Cemetery anti Crematorium
27 Quaker Road, Queensbury, NY. 72804.5902
(518) 745.4476 (518) 745.4477
htrpl/www.queensbury.net
Funeral Director: VA GC)
Name of Deceased:
Case Number: 3 ��
Date of Cremation: l ZaC)�
Retort:
r
Time Cremation Started: 5^
Time Cremation Completed:
Type of Container: CogL2� ���Z'v /iA("% N Win,
Remarks:
IA
,v
" Home of NnfitrnI Benit y ... A Cool Plnie to Live "
08/15/2005 04: 03 6104381631 TRA SECUPIT�' PAGE 02/03
i-r.r� tso�54a r5 WILCOX, Riwrir'l
PAGE 02
TOM or=QUi:LN�#31JItY
FINE YIEVV CCMZTr.ItY
C11 MATMIUM
quaker#toad, pueenslwry, New Yr4k 12004
P'mtle(61a)CMmatorrum 740.4477(I#►tv anewel)
Ceneriery 74544.78
AUMORIZATION TO CREMATr_
The wWwWgrard reyuesh sift,!oWjWFWg0 F'Ine View Cr
to ew lwiur+t In acuridarrcV wish arni,uGj+,�l
Its Wes end ReglulWbns to cre neft Mte trarmkm Of-
(N+ E) M le
Maritcalm Manox 335 MontaalM Street, Ticonderoga, NY 126F33
(Srnl: (CI (STATM) (zip cob!:) —
who dlW on 15 th day Of August 20 05
at Moseg diri ton t<1urs.in 1Home, TicoAderoga, New York 12683
(PLACE-) (ADDRE86) ----
Nerrm a►nd pic(ctress or neatest Liking I WWD or name o►parson euvlmr tittg creltte km,,
Julio A. Stcaax _3482 Chester ;)rive; M&CUngioiii, PA 18062
nelo trtwop to det eased Sin
Name of Fu nral Home Wilcox & Re Fune—-1 comet Tico�ndaZxoc�ra, NY
qNf MTAHT
l tepresON!hill to the best of my knowlwJve,V*deceased 1 pacelrlaker hi I08'or her
1101. (URCLC ONE)
i 001HY vial I iteve VO M pwrer and eugtarttoWn to arrange lac(he crm*Uw of ilto"rent�}s Ltd
Io dked Im dlWU$*ott d Wo aantatod rerc>akts,that any pWjatal p nmuWm have eNlt¢�Wit
be d and eQree to prated,defend and SWO lta n*u Pine VOW
Iran airy ad tI ilk - Old dmWWls for loss or damages vdtikrh In ay Ire ntada
99"Lhem t►y ireosm of or nortneded vrilh llte cro re t of.said renains as dkeuk d,VdildlOr
Mof(C"T
nWWO are Or are not WiKA r 9nUr# iess,lake or kauduIML
` 3JIt.1
IL 69 ES
(SIi "AT 01:REMWM OM LEGAL.REP.AND Mb"—S) s
Signed on Utls date: