Melanson, Mildred L O T IN OF QUL LL l.-L
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ Rlw4,..
Name M, ���•-�� Mc�� ,s��. Case# L19LI
Date Of Cremation
Time Cremation Started- Iy- '�u A
Time Cremation Completed
Type of Container (trcl� 1rF �s? CAS;=
Remarks
- MAZO o 416 A r1
�I -3s�n
i
10/05/2006 11:26 2072E34182 SENTRY HILL tJAUE U2
10/0E/2006 10;13 518-792-1287 PECAN&DENN`;' 41346 r-N-7,: 02
Town of 0two9mtry
Flirte.vow Cwne*ry and Crematorium
21 0uaker koed,Queepsbury,New York,12804
Cemetery Ottiow,(518)745-4476,CremeWum:(518)74-4-4477
Author(¢a6on to Cremate
The un4w lgnedkequasls and aWmrom Pkw View CremPorkrnt,in acomlanm with and subject lofts Rultos and Reputations tv
cremate Uta mmaing ct y I
t
cRy Stara / (ZIP Code)
wtp ded on -- - day of„�j 2t1 a e
fa (P��)gam_
Nerne and ed*m of ewmest irft rt wt m or^Ietrte of pesos+sutioi ng cnsrriatton:
�dlDY tt tip _
(►' 'I (Address}
Aelitilatsrldp to tha det�mased r
Nerve Of FiaWel*"ee C *sa d1_-
IMPORTANT: �J l
I represent rttet to the best ar my imowletlpa,the dWassed#49)orthas rlo pacwnsw,dudibrlitsW or any Mich Ur miy opersted
devii0@ In 1%or her body. (Ckt:lt►one)
t Carter them have r�l Gawat and atith011xetlprr tts,9rit!l7QE W*AM M00on Of the rwralm end to direct Rte dlvoyaiar,of the
crentiMOd rerrafnma,than many 0titor�e,heve @N*r beer!removed or Moy bie dasttoyed,and agree to protect,"adOnd and
wvG harmlew Pir s View tdri 111M tlrljrartti'a!1 rlmalm%t1siC tl nffl la Tor toss,*tltrtt "whkts they be m vde aVWm thwm
dy mason of or con w we metlon Of*mid rentabte mas 0MV. 0,wheltw.r WeCh t lefmm or demwYld9 oro to are ncK wholly
' �PiH7tf
ME , D 3/a 1
(Sitf►s��arst Addreas of Refettve r1r RaritatNa}�� .
etWad an this daft, Oy
bispocltion of OMMMed Rome"
I hemby direct Pfrws View Cfelnalortum to d*poso of the&W^,red rq o*w as fdWw&
roan to
O W WMNWrrMnb-Pleerte 9peeify,
If f ulveftatlton of cYernp W mmstnn is requmed,check hem
Revision:J9rugyty 1,2M