Arpey, Michael 't
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Pine OF Q U'EENS23 UR
retu Cturettry and Crerrtatoriuru Y
11 Qrr4ker Road, Qutertshury, NY. 72804.5902
(518)745.4476
hirP:/tom"v.queensbu (S 18) 745.4477
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Funeral Director.
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Name of Deceased: nn
Case Number. Z(GO
f
Date of Cremation:
Zoo 4
Retort: ZC('4&-1.j
15 T-
Time Cremation Started:
Time Cremation Completed: 3{3v h
TYPe of Container: r
uh�
Remarks:
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3 ' ��PM
Hoerr of Natural Beauty .,. A Cools Plnce to Live "
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: (518) 745-4476, Crematorium: (518) 745-4477
Authorization to Cremate
The undersigned requests and authortzes Pine View Crematorium,In accordance with and subiect to its Rules and Regulations to
cremate the remains of:
Michael A. Arpey Male
)
J
(Street) (City) (State)
(ZIP C�)
who died on 4 t h day of June 2008
at S�atoga Host Italy Saratoga Springs , NY 12866
(Address)
Name and address of nearest living relative or name of person authorizing cremation:
Melissa Arpey,
(Name) (Address)
Relationship to the deceased Wife
Name of Funeral Home Kilmer Funeral Home
IMPORTANT:
represent that to the hest of my Ivtowledge,the deceased(has)or(has no)pacemaker,defibrillator,battery,battery pack,power
cell,radioactive implant or radioactive device in his or her body.(Circle One)
I certify that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pike View Crematorium from any and all claims and demands for loss or damages which may be made against them
b�Keeson of or ed with cre lion of said remains as directed,whether such claims or demands are or are no(whoity
ndless,feI or udu t.
(war ess)
( igna re aT Address of Relative or Legal Representative)
Signed on this date: 4.� /V� / � aCJIJy
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as fellows:
Mail to
Other arrangements-Please specify: rJrn
If pulverization of cremated remains is requested,check here _
Revision:April 18,2007