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Gollhofer, Richard
OF QUEE9�50ur PINE VIEW CEMETERY AND CREMATORIUM �y QUAKER ROAD, QUEENSBURY NEW YORK 12804 (518) 745-4-476 (518) 745.-4477 Funeral Director LE r UPS Case# Dace Of Cremation M vo Time Cremation Started q;pp Time Cremation Completed Type of Container �„ad Remarks (: vo An 11:30 lZ' 16 Pn Cool. 11 4 ?P 5-P Town 0#Quemisbury )vine View Cemelmy and Cten Wd mt 29 Quaker Road,Qu 7r,New York, 12804 Gerffetery Off(oe:(518)7454476.Crsfrtatodm:(51$)745.4477 Auk ID CreMle The ttndeefs4gfW MCPAO eM WAWM Pkte VtRW Qf3ftMWtnt.O V-%end Stied to fts RtttBS and ReWtaiwa to Ovmste the Mnairts at Richard John Gollhofer Male (Nmre) (-qm) _9Q UDDer Highland Road, Bolton Landing,NY 12814 (street) (city) (-Kate) (Zip Code) ,,,hedWo, 22nd dw&January q08 at Albany Medical Center O O Name and address of nearest fivetg raiativa or ram of person atd vdzir 8 cremation: Paul Gollhofer 56 Beckers Dr . , Bolton Landing, NY O O RelattonShtp to the de©emmd Father NarraotFWWWHome Alexander-Baker Funeral Home IMPORTANT: I represwit ttvit to ttte bast of aW kwvAodM#a deceased(bm)or(m no)pacmilm,def3ar ,a3tor,taa y,battery tick,porgy calf,radloective urtpW#or ramie device In tds or hi r body.(CWde One) ON*that 1 Nerve Am Power and atmwrizz"On tv a mW for the r P,mon,i of so mmeft and t0 dW die asposkl0n of fttE kxerrumed rematlso that r&artttl po oAs ftsye 8Wm bees ar�be dt stnoged,and a gme to protect.defend and Sava trenntega F%mo -fim ntadafttea k m a W m d el t anrf 0 ages vdilch ur be made apabist them by reescn gtoa`cora d VAMBOCANNOWICtSM 1441 511# 68S 11 11 1 Vda#ter sudt r ar detltands and or are not vdx* fafse or irgktcertt. L4Tt6joqL AA ( ) ( Address of Palftm Repp+iiearftm) sO*4onftsdate: January 23, 2008 Ul spositim of Cmimead Remains 1 hereby drect Pisa View C nmatorl un to dispose of the cnmm ted reambw as follows: Merit to errsn9anterxs-Please spedfy If p WOUSti rr of memeWd remora is requested,check here X Revisicrt:VM 13,2007 nr!t;,!!N--..nrfz ff P;-- M . nn 07 -f-, I-- u icaz-ii BUJ Ifs v ii-, ain"f-A.-:41 ri.F 16- aj r--:s C-wl Vjc;i" v i I-- im;A a J"L,;jjj J Vi if it,-I rA- I jCZJ I IQ ar >�_ems -a Mw V-�sl,;W-U 4 4 6 QikV Q -90 mm be of a=mburt mmmm mz-mmfmin cT oDmah MI be accepteLi. ,was W ad --;.;e i lzfL�a f e-,we M hDM. the bodw betoM arty remains will be V W. It Lw-- rf%0042-4AW%A IQWM r_~� fi!w CAMIr-mv-tn -1 V.!n , x 1 to I Lamw On 61