Volpe, Michael OF QUEEN,5BUPy
PINE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director CA��cy�
Name toc C JAI PP Case# 37
Date Of Cremation -- v(
Time Cremation Started id= 39- PM
Time Cremation Completed
Type of Container
Remarks
htGv.
l 35 P11
a. Z)o �►'7
t''tw �n
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 urdersigned requests and aurirorizes Trine view Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of•.
Michael Christian Volpe M
(Name) _ _--- (S")
170 Cooper Lake George NY 12845-
("08/28/2006 ("o ( ) (Zip Code)
who died on day of 20__-_
ALBANY MEDICAL CENTER Albany NY
at
(piece) (Address)
Nam and address of neenast Rump reistive or name of person aulhorizng cremation:
Jody Volpe 170 Cooper Street
(Name) (Ad"")
Relationship to Via deceased Wife
Name ofFurwya!Hon Carleton Funeral Home, Inc. �R
IMPORTANT.
1►9preserrt that to the beef of my knowk4ge,rite deceased(has)or(has no)peoernaiter,defibi poor or any other benery operated
device in his or her body. (Circle One)
I certify that I have fuN power and aultrorfzation to arrarW for the cremation of rife remains and to direct the disposition of the
cremeW remains,trial any posprrat possessions have either bean rengved or maybe destroyed,and some to protect,deterd and
save lianrrless Pine View CrarneWrlrmt from any and aN dekrra and ri n x rrds for loss or demagas vi firh may be made against riiern
by reason of or connected with the crernal i n of said►emakis as dieted,wtwdw such Claiae or demarxis are or are not wli*
false or
(VYNrness) (Address)
(U. aWre and tWess of or Legal Representative)
Stand on rifts date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose or the cremated remains as blows:
MaN to
Oaw arrangements-Please spew.
if pulverization of cremated remains Is requested,check here XX
Revision:January 1,2006