Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
McElroy, Norma
T07+N OF QUEEVBURY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director NameN(22jyl 13a Case# Date Of Cremation i cr) C Time Cremation Started F-1 //\, Time Cremation Completed !22' :�3 0 V4A Type of Container C aO 13o,47- �/ YP l4 Al Remarks G,L " (� P Town of Queensbury Pine View Cemetery and CmmaWriuim 21 Quaker Road,Queensbury, New York, 12804 Cerrretery office:(518)745.4476,Crematorium:(518)745-4477 Authorization to Cremate The urdersipned requests and aut OlMOS Poe View Crmnatorhtm,in accordance with and subject to its Rules and Regulations to Cremate the remains of. _ Aloymfi (may) ) (Zip Cade) w at of ho on day of 1�ct 2D!b ( � f (Address) Name and address of nearest Ift refs or name of person eutho hkV rxacneNar. (Nome) (Address) Relstionship to the deceased Name of Funeral tome IMPORTANT: t represent that to the best of my kwoledge.the deceased(has)a: no sleet.�or arty elm baU9ry operated device in his or her body. (CkM One) i oerdfy#at i have"pawar and autlmrtaon 10 anarrpe for the of the remains and tc direct the Slip oaNion of the aetnated rernairs.that any parsdld poa sions haste aNher been rarncwed or maybe destroyed.and Spree 1O P'At.defe d nd an save herwrlessPhslflewQreM>r0wrortrea liom any and aNdebasandderrrsndstior toes artlerrrapes�rlrich atat►be madaapa>f�stthsm by al" of aroorsrarstetiwMrthe demaYan dsaid nerrretns as A net I N11091 1 sudr tieifae ar demands are or are not whoy gcoradiess,fiche or ftoudutem ppq .� .1011f 0' (Ad t� es)) e (Sipnehee and Address of oWn or Lao Representative) Sipped on tits date:, R�LG�: l !— ©E7 Disposition of Ownewd Range I hereby deed Pine View Crarrowd=to dispose of the Cremated n3 g*o as foNaws: iMd to other a„angemerres-PISM apacdy: tf pulverization of cremated rem airs is requested.chectc two Revision Jarerary 1.2WO