Dolan, John OF1r1. 1�,L
Q, rV,5BUr,�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QVEFNSBURY, NEW YORK 12804
(518) 745.4476 (518) 745.4477
Funeral Directoru-
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male Of Cremation
' ,me Cremation Started oC
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Time Cremation Completed � • �U
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Remarks
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Feb 27 07 02:34p Edward D Lynch FH Inc 17187864753 p.2
t7L/LblLt7c�! Gi:"Ll l�1t1474'L`14t3 BARTON MCDERMOTT FHN PAGE 01
Town of Queensbury
Pine Yiew Cemetery and CrttmatDdUrn
21 Quaker Road,Queensbury, New York, 12904
Cemetery Office:(518)745-4476,Crematorium: (518)745.4477
Autftorization to Cremate
The widniaipned nqu-n and&Abaa_pbv view G7eerW_*Nn,in awwdertoe wM and wj4W b as RUW and RM&ti m m
aeetaee ehe or
(BMW) (City) (Sales} (ZIP Cori) _
who toed on v�� Of
(pbm) (Addma)
Name and addles of rleeieS3 living MOW of name of peram authoegxo cnwnodM:
49<1 /9A-fAIf6-ca
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Rebabrtwmp to dta deaossed
Nerve or Funnrat Monte
IMPORTANT-
rvorm nt that to the two of my wvow►edpe."*deceased(has)Or(ices no)Paoetttdter.del slatur or any cow battery opmawd
device in his or bar body. (Ctrtde Or*)
I cste><y that 1 have hail Dower arW st Aharl�tfon b arrettps for ttte aetrtallon of Mte rcnaNMd ts and b direct V►e dsposiGon d the
�PlwMW a9et po SkN*hove aWW been tetrtwed armpy bo da aged,end la ,apse projq dt fend and
381*by meson of or aonrtttrol d YAM the*VmWian d eeid bet mft for bas ordamageswlid
&M metr mope 9peirtst thsrtt
p false or kuKkA nt. wf►ethar otrdl ds�n8 a demands are a ale nab MAt911y
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5rpnelure and I/1ddi�s d Relatltre tx lapel Reprttgena>Ylve} //G�/
Slpned on tNx date:
DWpoewtut of Cn KnSkd Remains
I hweby di W Pine blew(TeffOOM m ID tFWM of Ube VemaNd rerrtdlrMB as kalowa:
Meii to WWARD D.LYMM
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ON'-anartpwmn{s-PWsm Sppp(y;
n at*"erGMdon of GIC"abed fSMSI is is tttKluasted,d.edc bane
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