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Bovee, Baby Girl �O O� QUEEVBU9�Y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director S15,��.+' �Z-- Name `� ?, �-/ ( ; �'� �, fly % Case# >,J Date Of Cremation Time Cremation Started rj tc�ili� Time Cremation Completed Type of Container(� \'4�J� ,2,i Remarks Town of Queensbury Pine View Cemetery and Crematorium 21 Quaker Road,Queensbury, New York, 12804 Cemetery Office-(518)74.5-4476,Crematorium: (518)7454477 Authorization to Cremate The undersigned requests and authorizes Pine VWw Crematorium.in aocordarroe with endmAject to its Rules and Regulations to mate the remains of: 35 M 00A "/Oki Y�Z d (San-<e-' °(k) )9:3 (street) (ter) who died on _ day of " 'T—r 20 ©(p at - h") (Address) and address of nearest Nving relative or of person cremation: (Nemre) ) Relationship to the deceased Name of Funeral Home —-- IMPORTANT: the deceased(has)or�nas�qt peoemek�.defibrillator or arty other battery operated 1 represerR tlrt to the best Of my Ivrorvledge, devkvi in his or her body. (Ckde One) I cw*that 1 have hA power and aul mization b ertarrge for the cremation of the remains and to direct the disposition of the aemated remakrs,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and reason orof connected crernali n �remains dkecN4 whether such d or demanddam be ffgwe agwist them or are not wholly false or fraudulent and Address of Relative or t egal Rapnmanh*l re) Signed on this date: ! D(p Disposition of Cremated Remains I hereby direct Pine Ylew Cromowmm to dispose of the aernated remains as fokmrs: Mail to other arrangemer+ts-Please specify: ryl pS6 A If plAwmBtion of aemaled remains is requested,check here _ Reviskrn:Jaraiary 1,2000 I