Altizio, Michael .L o"tiN OF QUEEN,5BU-r! y
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURy, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director C --� _
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Name t e � �-��� ��v
Date Of Cremation
Time Cremation Started
Time Cremation Completed ; UG Pfi
Type of Container
Remarks
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Tovm of Queensbt fy
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 rxdemigned requests and aulhorizes Pine View Crematorium,in ecoorderme with and subied to its Rules and Regulations to
cremate the remains of:
Mr. Michael Altizo M
(Namel (SOX)
(Str") 12/13/2 0 0 6 (City) (State) (ZIP Ulde)
who died on day of 20
Glens Fails ospi a Glens Fails --7Y
at
(Place) (Address)
Name and address of nearest Nvirrp relative or name of person auf orb*V cramation:
(Name �� (Address)
Re ip to the deceased g r o 4--Lai -
NameofFurmalFlonNi Carleton Funeral Home, Inc.
IMPORTANT:
1 apresm that to the best of my knowledge,the deoeesed(has)or �pe�rI def Ibrllta b or any other battery operated
device In his or her body. (Ckde One)
1 cmtify that t have U power and auttrcb*bn to arrange for the carnation of the mmelrs and to dkW the disposition of the
cremated remains,that any personal Possessions,have either bow removed or maybe desboyed,and agree to protect,defend and
save harmless Pine View Crwishmiu n from any artd all debts and demands for loss or damages which may be made against them
by reason of or connected with the c emallon of said remain as dkecsad,vNtelher such daims or demands are or wholly
Kim,false or lent.
"blow) � (Address)
Siena of Reiattve or t.egaf Representative)
Signed on this date:
Disposition of Cremated Remains
I hereby aired Pine View Crerrreaorium to dispose of the cremated remains as follows:
Map to
Other armngemerrta-Pieeee spew. _
If pr kwization of cremated remains Is requested,check here XX
Revision:January 1,2006