DeKleine, Rein OF QUEE9�5BUT
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QjEENSBURY NEW PORK 128D4
(518) 745-4476 (518) 745-4477
Funeral Director LEYAPPEI.
,Name Re1�,
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Date Of Cremation
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Time Cremation Started )
Tame Cremation Completed IZ :Kp
Type of Container oa�d
Remarks
to So
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Town of Otmensbtuy
Piro View GenxftiFy and Cremakwknn
24 Quaker Road,wry,New York, 12904
Cewieftry Offfm:(518)745-4476.Gremac :(518)7454477
Ate to 0emate
The undef d requeo wd aullti wbw PD* Qme%Mmx in I wW to as Ruin and RMftftm to
Rein DeKleine Male
(Nm*) (Sax)
25 Old Mill Lane Queensbury, NY
( ) ((may) (Site) (Zip Code)
v„ odWor 23rd dwat January 2008
at
Glens Falls Hospital
( ) ( )
7 and address of neatest``�relative or name of person aLdhari=V cremation:
e- lCl4 L Gv
(Na ) (Ad )
ttemmor ago to the deceased ":;:�Tl
NarreofFunwalHome Alexander-Baker Funeral Home
IMPORI'AW:
i repnoM that to the best of msy kwwMdge,the Ono(w fm w)pwonaker,deftillaW.may.bWtwy peck.pow
cell,radioactive implant or radloadive device in his or her bW(Code Owl
I oerWy that I hwm full power aid won to arrwW far to aeattt of due MWAft amd W dW fire dSPOSWn Of the
cad remasss,ttsart ar►y Aersossat paeseesionstvave beers or stegt tie destroyed.and agree to psclect.defeM and
sane harmless Pine View QnanmWrl m from ary asd ati cbh. wd I far toss c r damages vrhkh wmy be media agabM there
by reason of or eonnetsed YAD fire won of said rmsn bn as d MN2ed,wtrether arch ckft s Or desmards are or are tat wholly
gmurdikw%false or Bent.
(vvw�es�i (Psldress)
(fie&d Aftess of Reii.e or t eW t>dim)
s9gracl on this date: January 24 , 2008
ubposition of Cmwm*d Remains
i hereby*act Pine Vow Cxemetorlm to dlspme of the c nmwmd remelts as fokws:
Mail to
Oiler ariwxwf m-Please spedfye
if pulverization of cremated mmem is requested,check two X
Revision:,Vm is.2007
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