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Corwin, Hamilton OF QUEEN,5BUr�y PAYE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director_ Mt� fit Name_ ��mt Itu� (Urwl-` Date Of Cremation S . Z ZOU7 Time Cremation Started Time Cremation Completed 10•,00 H Type of Container Car rc� T" r= 15, CA Remarks A f7 cool / d '0v 411 I I I Town of Quee dx" Ph*AM Cemelmy am Cromebam 21 CAWw Road.Qumobwy,Now Yak 12894 Comelery 016oe:(518)745-"76.CromfAorh,inK(518)746"77 And ckwvmw The WdwlbWfS M w dMdNO s PlnaVbw On Wabrko%haooardrwwrrlhw d.mdjwto bnub w d pAW* oM to a�I win ft IN r NJ @ at �1 A1`I l LjpA/.S Cog iA/C4/ 67 Ry can G PW (woody wfwdltlon 2 6 dWal rdewwaw, -in rskm sarwaw cry 1 sansn-A 1,,- 9 6 7s'UGA1ZWQM er WAI �avw*a w Seiy lvwneaf rtaa.�L _.L,4t21< . /et c l iNpINNK vo to eMt of or lnowlerpa,t�deasaMd�ej a�iis�n Pacwn�loer.d�l0rlor4WNWGNW b@IMW p►Mal1 dsdcslnMxarhwb* BOkbOwq 1aw*#Wihmfdpo wda -orhp�IwiNaaimlwt riaowmrMoeraflAfnlwariaaMtodl�ct dNpoarondlAa aameMdtht ► aelMrbowwwnowdarwr�rb•tiiMwl�rl4,awd#gAwtbpfil g,defw 'am sw�ehe�sreesPMlilwOaaa�luwMflewia�a�d�te�6bsa�i#.dlwwwdt►far�ard�eswaP��ds �.. irtrwruoAdaraawrr.�ta�edltalanlr�tfiQs�dt�lNAMfsbs't�CM4r�s1W a�sar�dssntaraie natwNoMtr panar*auou�ene. .S v ltirollk� 1�w4 y 44/cE !'cA mil, NY SWwd an eat dsW SLAT_ 2.6- Zo o,7 , oMpodion of awn W Rook* !lwi*ydkvdPrnsVlmwCwm*xlmnbdbpmofft p ,wMMdaemaiwaalbN m MOM AUR.Madt.Am Ave. eke Plarlrl Nv_12946 wwrN 0-90 --,"-Pbmapaaffjr: IfpW-ariwdon of ww ft M ngiasM4 ahwic rw+r�_ POICI , Rules and PAguMbM 1- �sCmneWd=is i xxM on the grounds of pke View may,The OPO i°e n Monday KooFrklmyftm 7-.Wm to 3MM.Per Wohone r409ftwy fur&Mrftcrwnati m 2 A `Authoria dm for G snWk)"•8%Med by the nearest rraxt of kin is skghV and have Of 10 ararge 1brote a ram y ti��� +��. s+mess ae�ri p f Mnoled��o�Oer�fM�!r'1f_f�11��eL�+r+Me dernopes which may be m Cmrawm�a� d�rlds the Oen Wm ctsM remains miibr�nW m Imn by Mason of a tscOs 1 with ow addOm to a e or eu ,T�lion in nWdsocwk e w the rerfd*w 3. Al mnaks nwM be in a caeioet ar must be ofs c .hb sibrnels � container. end hers fmn or Pksdc='da WWW N be accepted, 4. CardW MonakeM ftUft B or o5rer ball +Y operated devices rr, 1 be romoved before aW mnaft wS be accepted. 7'� w"three days(72 how)of be nwwm !ems Qf the �leAi�arsd u.&Mel w Fain:?ns COM servios unless cihac dep o` n tmm torthis service, as madeo 1lrwewN bee$30.00 charge 6. ,Ackn� Coats and.ftWrclkV fees: Adult Ptifdren (Aga 13 months tD 12 $17&(* iMants (sWborn to 12 rrro�rrths) $125.00 NEW YORK STATE DEPARTMENT OF HEALTH Vital Records Section Burial - Transit Permit Name First Middle Last Sex i4L-c Date of Death' Age If Veteran of U.S. Armed Forces, v0 S War or Dates Place of Death Hospital, Institution or -64y, Town or--V c #A&UWs ,,, Street Address E ,L L G45V?FR Manner of Death Natural Cause ❑Accident ❑Homicide ❑Suicide ❑ Undetermined El Pending Circumstances Investigation Medical Certifier Name Title y/M 13 —r,9 A TvJ' H D Address Death Certificate Filed District Number Register Number Town jF w 16 4 3 Date Cemetery or Crematory ❑Burial J'^ (, 2D07 C K A rPA Address ©Cremation LF J /=Aj-1..1 N Date Place Removed Z❑Removal and/or Held ••• and/or Address Hold Q Date Point of N ❑Transportation Shipment 0 by Common Destination Carrier ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home A •B•%lark %c• p Address Lake Placid, NY 12946 Name of Funeral Firm Making Disposition or to Whom Remains are Shipped, If Other than Above Address [ Permission is hereby granted to dispose of the human rem 'ns described above a dicated. Date Issued 00112-CleX Registrar of Vital Statisticst (signature) District Number IG63 Place I certify that the remains of the decedent identified above were disposed of in accordance with this permit on: LUDate of Disposition a? Place of Disposition f t �lt•! l fY�,ct �r�v.� (address) LU W (section) (lot number) (grave number) GName of Sexton or rson in arge of Premises Art's aNnctf z (please print) Signature Title (over) DOH-1555 (9/98) rr0rN of QUEEN,5BU_r�y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QijEENSgURY. NEW YORK 12844 (518) 745-4476 (518) 745-4d77 Funeral DirectorM((3 ` l tit Name G rn I ('�' (arwi—, Case# LlIZ Date Of Cremation s . Z 20U� 1 i I Time Cremation Started : 5-5 Am Time Cremation Completed 10.,U0 tj Type of Container ��r Remarks 4.-O5 Aw C06j I o 'ov n Town of Qmm*" Pkw View CWMI Ny end Cmmbdum 21 Qualor Road,taus WMy.New York 12W 4 CwnoWy OIRae:(518)745.4476.Q nwW*w(518)7454477 r�ion fu Craneb Tfo l III elgwdeegiooMdautaOmPbsVkwQaA %baoCOtd mod was ftmodituk wb ceemsl-ft to a06 met d Al`l Ll-'Q 5, CO f IAI I& 67 (maw 0-4 low la czacod•>! wdbedon 2 4 $Nor J`EpT � at 19 M c .s',� l-L4 �' ..Arm., (P" (Addease� 04w"w as 11 of esaor a�pwlowar 1 m 4wwnoa armg 6 7 Wegyr WAI }-!I LTo-V ln/ CO24•/,L 4AJCE I LA Qp /V.y- Re�IsllpfNlllpbresdeoeMsd .Sd/l/ l+eP� nt�atbfiebe�tdogrla�iowls�po. deceradAo�a esi P .rd 0MarWWWQdWb�yIII 1 0 a 4 dsdco b his or hrr bo. (Ckb Ong a�Myw�c�n.M.�rpow aidaabodblrnba�rarp.tort.awawanaf�h. .�ai.ad�odlii.ccil�rdlr�oNNanam. ceaeaMsdewenitts,tlett or�rbMn•�IswdoFUMlpalMka�arAebpoMr:R dsferdanti ss�sNe�sieoP'Ms11lwlaillfeeiaa�o�lellan�. tetbs� s, �g;bc� �rr.eondorow..awt.red+rsarm.anars�drwca.Niss�asa�,�ur.uaa�sQrd�■�es.�earare nocwhoM�r �toetta�wteQueaea. the v � - 1p-1.9 4/a,A/ 7 .S u ,woRJcJ 4w4 y 44 KE' PEA�4 SWW an Mb dmW SCAT_ 2.6y 2-o 0 7 OhpoeMM of C Mn tbd Fknobes 1 lw*y d and Pbs View Crmmm odm b d k mes offt as fc wm Md b A.$.OWL.30L Ave.MaJLU SEEM— Lake Pladr1 a I294s OWN a 001- m m-Pmm oporftr #puMaelta11' OfotsaeeMd ONFA N b rNP1881e4 aleedc IIM�(T lbsi6tiaer.:aee,�rr! Pokim Rules and flepuloftS t. Pine Vbw t�emaeorium is ioa d on the grounds of ping yam„Ownwwy, The � ryinr�aturdsy Wia x�.. ����� . a� 2. A `Authorit ft for OwnW on•stned by the gear neW ofidn is neceemy p maid w W of V UWWFIY 10 for 00*Wnatbn of.the nwairm harrni�Pkw VteMt� ar y�g ID�� Id and aam' Utwy and itelow ofdemapes rM"rra�ymay mode tllern and ei1 tdaNna and d�nds _crernelion ofesid�m a�'dleitbn Of rMPAft=a' �scyed with addition to ae°r�-'1'torf�tion in acoommw the rmru�e 3. Aa mawkM mO be in a ca®iaetorsrlt" must be of a emote loots and Cardiac ��er�.!Vo�or c conlekergr�be soo epted 4. w��be for oatea-bet6ery operated devieee merst rsrno�ed " sw wiM beC*l� throe V dspeta{?2 hoes of # b �enadris wN! sd vm�l U.&Mal wNhfn tixae Fates fie aenreioes offer 1000*stal home anrartpeansnts arm made:Thee vA be a S0,00 chero 6. CfSnWbn,Ad***Won Coefa and Adult $325.00 men (ape 13 nKnft 1a 12 infers (s bbont io 12 m ) 25.00 Overtirni� _ rils+ew\ l�r.n^w ahoy CS •� �'.""'.7Qf i(."/Kr�i�f.S//�f/i� "�"'`''I'll �0.00