Beattie, Clarence OF QUEENs0 u(QQ
PLNE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW PORK 12804
(518) 745-4476 (518) 745-4-477
Funeral Director
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Case#
Dace Of Cremation _ Z' _ OS
Time Cremation Started : p S
T :me Cremation Completed Ph
Type of Container woo �s� ��GW ZiU C'
Remarks
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own of Quee>rbtuv
O'm View Gov and Cremabodum
c i Quaker Road,Qtmertsbury,New Yodr,12804
Cemett q Cffft me:(518)745-4476,Crsmaloftcn:(518)745-4477
AUUXAZOM OD Cie
'?ae undefsow rtqum Its aul wtms Ph*V Qwn*ftm in v,ft- tit lob Rules 2nd Reaubtiom to
c rend a the reffolm of
Clarence Beattie Male
(NSM) (sett)
69 Washer Hill Road, Johnsburg NY 12843
(Street) (City) (state) (zip code)
whodtedon .22nd dayot January 20 08
at Glens Falls Hospital
(Place) (mew)
Name and address of dearest rnving relative or nairre of person mAwnemg awnwon:
Vonda Beattie 69 Washer Hill Rd. , Johnsburg
Q"TM) ( )
Relationship to the deceased W i f e
Namo,FrtmwHome Alexander Funeral Home
IMPORTANT:
I represer#that to the best of aq knovkKlge.the deceased(has)or(Etas no)pacwwker.deffixNator,battery,battery pads,power
call,radioactive bositt or raftecdve device in his or her body-(Circle Om)
1 oer*that 1 have U power and auftd=*m to emgP far the re Ars of t w tuts attd iD eea ttte r bn of the
trernated camavm tea pow have e0wbeyremmed os m"be desbDged,ant aWee tt?protect,defend and
save herml flea View aborhrrn ftm any Wd as cbh. and I I t rbw ar I Ps whits armor be made agebnst them
by or Eire moss cf said ram>abUas slRectad,wttlw sect daim or detrtende area are not whogy
terse a -
G✓1�i�wS�.vu.
(Aftess)
( Ad M of ReftW or LegetRepssentwve)
SW.da,tftdg,: January 23 , 2008
UisposWoa of Cremated Remakrs
I hereby Brett Pme View Cremnorham to dhWose of the cremated terrains as Mows;
Mad to
Other arrarwmer es-Pmase specity:
If putvermatlon of mema►ed t wmhs is requested,check here x
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