Frasier, Kenneth TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
21 Quaker Road, Queenshnry, NY. 12804-5902
(518) 74 5-44 76 (518) 745.4477
http://w\v\v.queensbury.net
Funeral Director: f3
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Name of Deceased: - X TE N N] e �4 �v i
Case Number: O 06 2_0
Date of Cremation: l — 0 - 2 aG
Retort: �� 1Q LC) �6 1 `�J
Time Cremation Started: 22
Time Cremation Completed: `J O
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Type of Container:l9- l C 1` 0 S!< ��
0 1 b�V
Remarks:
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" Horne of Natural Beauty ... A Good PInce to Live "
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12WK
Cemetery 4fiioe:(518)745-4476,Crematorium:(518)7454477
Aut xWW3don to Cremate
The u ndosowd requests end au d tws Pk 0 View Crenr WAd m,in amorderm with and stMed to its Rules and RWAe*m to
c ren u to the remakes of:
l,/ CNDf /y -
. (Name) (�
I o&v 2- 7 /
(Sreet) (CRY)
who died an S day of sJ Z(i ZP
s ►T
( � O
Name and address of nearest mMt m or name of person&AhwkkV a noon:
(Nome) (Address
Reledo WW to the deceased
Name of Fmwai dome Z
IMPORTANT:
I represent that to the hest of my kWAIIedge,the deceased or nq) txtAsttxorvWo#wbskMrYqmsWd
device in his or her body. (Circle One)
i ON"that I have full power and out WW3don to anennpe for the aennellm of the remakes and to d�the dispoollion Ogresofde ecxi and
cremated remains.that any personal p he"ettlner been removed or may be desboyad.
save heronleas Pine CremsWka*M arty end aN dWna and dennnerds for loss at demepea which may be made apainnst them
a wNh the cronalioa d remains as dkecsed.whWw such datrnrs or dernmrnds are or am not rda�y
groundless,false
le
2
of Rekdmoruqd )
on this data:
DWOSMWof
i hereby tired Pkm view Crenmoorkm to dlapose of the ownsted remakIS as MOM
MeN to
. ogner artargemeMs-Please spacNy: � � V
n piveftation ofow aced remekns is mpisted,check here
Revision:,raMWY 1,2WO