Parsons, Helen V '
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F/ U L L
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WE V1EW CEMETERY AND C
QUA-kER ROAD, QUEENSBURY REMATORTUM �y
�W YORK 12804
(518) 745.4-476 (518) 745*-4.477
Funeral Director 147
NameN w,�It'tOL
' �t�(l
Date Of Cremation
2o(g
Time Cremation Started
Time Cremation Completed
Type of Container + p
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Remarks
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Town of Queensbuty
Pine View Cemei>Isry and C romakidurn
21 Quaker Road,Queensbury, New York, 12MM
Cemetery Office. (518)745.4476, Crernatodum: (518)7454477
Audi Amlion to cremate
The wXIwsi9nad r+eglueets and antthorf NS Pk*v9aw C?rema ium,In,acnordanoe v t►,and a 4f ed to Its Rues and Regctions to
orLelr�n
eft emains the r of
(Nome) moo
6.� (� (Z{et 9 ill� 1zd3y
(Street) (city) (SUM) (Zip Code)
riho died on l 1 b day Of �o✓ � Zp_Q�:
at G tee s_r 111 ��S�,,4,
(Place) (Address)
Name and address of 1,0 0 a Vvbv relative or rums of Palo or►*L ttwrzatp asmixom
S", a 1-e y I
(Nam) ( )
ROWDOMN9 10 rW deceased S v-n rr''
Name of Funeral bias
T
IMPORTANT:
I rawasent tug to the beet of my knowledge,the deceased{tree)or(has no)pacemaker,mar,batt",boll®ry pew,pry
cell, it rOo t or radioacOve device in his or her Nosy.(C kOe One)
i oar*that I tie fait power and audw iz ation to arrange for On costs ion of the remoft and to dkW the disposition of the
c rOMO d rarn**,00 any PWO ►M posesseWo have either been removed or may be destroyed,and agree to protect,detend and
save harmless Pkw View Car+ertceitortm fiam any and aM dsirrrs and demands for iias a damages whk;h may be trade against them
by reason of or corrrscled wM ft crametim of said,orwA s as dk eck4 whodw such dshee or dernands are or are not whoNy
false or kaudusnt.
CJ tom) (Addrm)
17,4
(Sigrwwa and A�ciaress of Reba or Legal Represertath e)
Sigr+ed on date: 1 / ( 7 k�-
titio,a CmffwW Rerrolm
I hereby dkW Pk*View Cnowaium to impose of the cremated rernetns as toflowar.
MeNa
cVwarra >erits- arm►:
If Mien of o mated roonaft Is t+sWeeted,dw&here
Revtsim April 19,2007