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Donohue, Mary
2O`/tiN OF QUEEN,5BU-rR,,.y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSB RY NEW YORK 12804 (518) 745-4476 (518) 745"-4.477 Funeral Director MQ�Name � 17 C a s e# 5 � " Date Of Cremation 6L Time Cremation Started Time Cremation Completed 46 Type of Container t Lcgr � ��- � i S C St Remarks w T" T- t1 a Maw 167 M ? ' d �L0 Ah 12/23/36 11:48 UPMEP 4 518 793 3641 N0.246 P03 32I2312006 11:©4 518-793-3641 &ihlG_L-TUN/5U:L1VHN rcxaa� U� town of Queuresbury Pine View Cemetery avid CrletnutuOuilt 21 QUak4r Road,dueensbwy, New Yotk, 12804 Cemetery Ofnce:(518)745-4476.!~rerlldffFf)Uftt: (518)7454477 Auftl`irdllan to CfePTIOle The undereiEined regU9sts and authariZe8 Pine Vbw Cten'►etohiurht,in alxohlancce will+cars!OiAlvid to its Rulest enQ Repuisiterns to crenreta Vie remains of: Marl , (Strati) ` (State) (zlp r:ale) v�tq an 22 /dayof ny�C ..�llF1Y' . _.�..�f2C0P11 al �r7 F"0J 4 + tJ.t,�c�..- rC!\ (Placyy) VrddrtiM) Name end addre6e of nearest 110!I ieirolve or rarnB of petroot O►Aiwrl;htfjy ciam-9atkyl: I(c VA i (Addiow) Relalionahtp is the deceeaed k1tf4ZhL —--- .. ,. _...._.. . _ Neime of F Moral moms I Q�tM c i i1 e! l �— IMtM)MANT: t►eweaertt oral to the bens of my kwiewledpe,tlw dor�weed(Iran)a p vas(a)Pamensker,jokohalor or"olbW bstt*Y aperptt�d ttevive m tWs or har body. (Clrc4 OM) 1 c n4y MI t have hA pp%W oM VA) a.8tion to @43( 6 for the cywnst4t7n Cl the remotes and to direct the dispaesilon of the crarnated remaha,wei arty pereonel poesesabrm hove~been rtrn+ovW or mey be Oeytnvysd,"I 8pr9e Io prt IM.00*V end aava harmkss pile V Ww GrrxnekAutm born"and eft cla me and dameniix for was ex demagAn.utikil rrwy be rnWM Soo*Iherrr try reason of or ownneded with the awti lion of go remsiu as direded,whether such cWMS OF tiW'a xb WV of ors TO WhOR r arol,Rldtetit:,falek of tr,VudtflertL lure Aiddre s of Relative or L"M Refxe9enlalive) Siprwd on this 091e: 06 pi,sposiliono(Cre'Mwled Reiriwrls i hereby direct Pine View Ducnakwit ro 14 dWpM of the cmmeled rernskts tIS k-AIU s: M4410 ether anranperneroz-Plimse apedly: �?'-iti—fir'. it puivarizaiian d cremated re*m'.ns is requarled,chew here Revision;JenuxV 1,M