Terrio, Wilfred TOWN OF Q UEENSB UR Y
Pine View Cemetery ntid Crematorium
21 Quaker Road, Queensbury, NY. 12804-5902
(518) 74 5.44 76 (518) 74 5-44 77
http://w%v%v.queensbury.net
Funeral Director: )�� (
Name of Deceased: (vlf L F0-ZEU
Case Number: t
Date of Cremation:
Retort: ::'j-CE,
Time Cremation Started: �S D ►�6�'l
Time Cremation Completed: 44-
Type of Container: Ob
Remarks:
�5 15-414�
Z4-C) 3 A--
" Home of NatitrnI Benut y ... A Good PInce to Live "
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury,New York, 12804
Cemetery Office:(518)745.4476,Crematorium: (518)745-4477
Authorization to Cremate
The t mknrigned requests and autwtws gins View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remelm of:
Wilfred J. Terrio M
( ) (SOX)
1092 Dix Kingsbury NY 12839-
(')03/01/2006 (City) (Stale) (Zip Code)
who died on day of 20r,_,
Kingsbury NY
at
(Place) (Address)
Name srtd address of nearest Bring r9Ww or name of person wA xx * o nretion:
Carol Terrio 1092 Dix Avenue
(Name) (Address)
Rslatl0110hip to ttte deceased Spouse
Name of FuneralHoms Carleton Funeral Home, Inc. T'
IMPORTANT:
I roprseent that to to beet of ny larowiedge,the deceeeed(has)or(has no)paosmalter.defitt than or any offer battery operated
device in his or her body. (Cirds One)
I ow*that i hove full power and suthorbatbn to emerge for the cxerrokm of the►emelrrs and to direct the 0119poeltIm of the
c►eerated remains,taut any personal$c 4 a e 1 s Iuns have ekher bean removed or mey be desroyed,end agree to prolect,delbnd and
am Iwxnrlses Pine View Cretrom rlum from any and all chi, and demands for ions or damages wtdch may be nude against them
by iseeon of or er, ar'sd wfttt the aerrtebort of seld remakts as dlrectud,wwttelher suds dttfta 1 or derttands are or are ra wholly
vot;w"N'false or
6
( )
(Signalise and Arditss of ReWwe or Leo Represert aWs)
Signed on fits date:
Disposition of Crom?Md Rerrtairis
I hereby " n r'Pine View Crerrretodum to dispose of the aeumited remains as Wows:
MeN to
Other an'angementa-Plow spedfy: _
If p Averbatbn of cremated remelne Is requested,check here XX
Revision:January 1,2006