DeLuca, Wallace OF
M�TERY A
ROAD, QU8p�1SB ND CREMATORIUM
(S18) 74S.4-q76 �Y' 1`rEW YOR}C 12804
(518) 745.4.477
Fame Funeral Director
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Cremation
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e Cremation Completed
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TOM of Queerm"ry
Pine View CXww tery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)7454476, Crematorium; (518)7454477
Audkx zaWn to Cremate
The wxie Wgned requeft and awes Pk*View CrernescAm.in s000rdenoe with and su*d to ks RuW and Reguwi to
c"wt to the rewskhs of:
c.
(Street) Ply) (State) (Zip Code)
rrtfo died on day of 20_49
at
(Plecw) (Addrase)
Name and addr+ersa of rreere4!vying M1860ornenwolpow eUtho b*v cremation:
Marcia Anastasia 31 gent gal Ave_ oupensbury., Ny 12R04
(Name) (Address)
Relads mft to the deco tied DaUghter
Name d t=unwal Hans Carleton Funeralh Home., JNc-
IMPORTANT:
I reprew t Ifit to the beet of my W vModge,to dvoeased(trefe) maker,deflRar OoW,bettery,beutery Pack.power
+cad,�Irnplarht or raftec ive clew be In this or h r body.(t rcte )
I ow*to I ton U power and whor ration to arrange for the ownedbn of the renrakre and to dlrers the disposition of to
aenv tad romeb s,Out any personal posfsssekohs trove sW or been ranrovad or nhay be deedroyect,and agree to potect,defend and
save them*m Pine View Crornetorium fiom arty end aN dairrrs and darnan%for Am or da naps whk:h mey be made agOnd Nwn
by rssevrt of or cxrrhnscwd wits tttf cremation o1 sort,w,w rrs wdroosckwhedormchc1oln or dernartt are or ere nit om ly
yrvtehdloe,fate or it
arid or t )
Signed on this date:
Dispaskim of Crenated Remains
I hereby drsd Pine View Crerrhatod m to dispose of Ufa cremated rornains as ftiovw
Moil to
O"W erra vonero-Pleme sperm+:
a pulvrrRft t n or oerf d rerrfetns Is requested,crate here
ReMw"r:Apr9i 18,2007