Swinton, Oscar TORN OF QUEEVBU�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director RjcgK�
Name VS[.af 5 V%1GL Case#
Date Of Cremation jU IS /G';-
Time Cremation Started 11 = qU �M
Time Cremation Completed �j • l b
Type of Container wood C65,Kt-r
Remarks 4 L
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PIMS VIS1� Cam=
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Quaker Road, Queensbury, Nay► York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTNMTiMOK To CFANAW
The undersigned request and authorizes Pine View Crematorium) is
s
accordance with and subject to its Rules and Regulations to cremate
the remains of:
(Name (sex)
(Str t) (city) ( torte) (zip Code)
who
died on - ____�day of
$ At LZI
(Address)
{P ac )
Name and address of nearest living relative or nauaet person I
authorizing cremation:
Aud 1� D &',"
{Name { e ) i
I
Relationship to the deceased n
4 Y I
Name of Funeral Home
xMMMORTMT: the deceased has or
I represent that to the best Of MY 1nO�C��e oa®)
has a+2 �acemak8lr in his or he y•
aatd anth+o�riaation toy arrange
I certify that I have the full Purer diSPOO
ti�on bf°'
for the cremation of the resoains and to direct the ,
poesessinn= . either
the c-resated rem i • that any e , �.�
and agree Ps'a't-�'k .
b� te�ved or say be • �r-and i
save haraies6 Pine vies► ma frcea any and an � ' ' ,. by
demands for loss or damages which may
remand of or connected with the cremation .of
whether such claiss or demands > lly ,
directed,
groundless, false or fraudulent. _. '
s { esi
(w to )
Or Le 8 Rep. an +�+;?
(Signature o Relatl. e Q
Signed on this date: