Traver, William TOWN OF QUEENSBURY
Pine Virtu Cemetery and Crerttntnrittnt
27 Qunker Rond, Queensbury, NY. 72804-5902
(518) 745-4476 (518) 745.4477
http://w\v\v.queensbury.net
Funeral Director:
Name of Deceased:
Case Number:
Date of Cremation:
Retort:
Time Cremation Started:
Time Cremation Completed:
Type of Container: 11 14 iiq
Remarks:
i
i
" Home o NntitrnI Benito ... A GoPd PInce to Live "
I y
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queenstwry,New York, 12804
Cemetery Office:(518)745-4476,Crematorium: (518)745-4477
Authorization to Cremate
The undersigrad requests and auftwizes Pine View Crematorium,In a000rdance with and w4ect to its Ru"and Regulations to
aemata the muss s of:
William Irving Traver --M
(Name) (SOX)
8 Bridge Street Fort Edward NY 12828-
(Street) (l/) ( ) (ap Code)
who died on 9 t h day of January 2006
at
8 Bridge Street Fort Edward NY
(Place) (Address)
Name and address cf raereet WkV relative or name of person nuftding a mnation:
June Traver 8 Bridge Street Fort Eward, NY
(Name) (Address)
Wife
Aeia 0 Whip to the deceased
Nam&Frarere Hama Carleton Funeral Home, Inc.
IMPORTANT:
i repreeerrt that to the best of my knowledge.the deceased{tree)or(has no)pa mw iter,deTibr k*or or any other battery operated
device in his or her body. (Circle One)
I cry that I twm Nil power and autlrorizobn to arrOW for the aenredw of the remalns and to dked the dlsposWon of the
rrem W9d remains,Mat any personal possessions treble either been removed or mW be desYoyed,and spree to protect,demand end
save h wmk=PNte Vlsw Crematorium from arty and aN dW=and domes ds for kas ar damages w ich n"be ntede apakrat tam
by corroded wkh the(tatrteMotr of said noo is as directed,whether such dales or demands we or are not wh*
or fraud
./j� - atom Funeral Home, inc.
::�and
(Address)
�orLOW
rt Edward, NY
�Addrmmw�RekW&Wv RepraaertiaM)
C.
signed on this Bete: 1/1 1/0 6
Disposition of Cremated Rmnaw s
I hereby direct Pme View Cremstorknn a dispose of Ow amneted remeims as tNows:
M81 to
Other err rmlerttertts-Flow speGhr: -
d pulvertratian otcremated remains Is requested,check here XX
Revision:January 1,2006