Winslow, Edward r'-o c14N OF QUEENB URY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ��PWrr
Name FAWA(c, w �n5�uw Case # Z �
Date of Cremation 2005
Time Cremation Started L U Rb
Time Cremation Completed )0 - tt' AM
Type of Container Frcl vcl/� o or �� Fi t j ct'
Remarks :
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Town of Queensbury
Pine View Cemetery and Cremat Drium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Ofkm:(518)745-4476,Crematorium: (518)745-4477
Authorization to Cremate
The urnieraigned requests and authorises Pine View Crematorium.in accordance with and sul)jact to Its Rules and Regulations to
cremate the remains of:
Edward S.Winslow Male
(Name) (Seek)
131 Lawrence Street,Saratoga Springs, NY 12866
(Street) (may) (Stale) (zip fie)
who died on 27th day of June 20 09
at Wesley Health Care Center,Saratoga Springs,NY
(Place) (Address)
Name and address of nearest living relative or name of person audxxt*v c remedon:
Andrew Winslow 188 Howe Rd,Greenfield Center, NY 12833
(Name) (Address)
Relationship to the Son
Name of Funeral Home Brewer Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or malaer,deftilledw,battery,bettery per,power
call,radioactive Implant or radioactive device in his or her body.(Ckde )
I certify that I have full power and authortzadon to arrange for the cremation of the remains and to direct the deposition of the
cremated remains.that any personal possessions helve either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crematorium from any and all *1 land demands for loss or dernages which may be made against them
by reason of or connected wkh the cremation of said remake as directed,whether such claims or dertherxis are or are not wholly
groundless,false or fraudulent.
(witness) ///7 (Adam) j
(Signalise and Address of Relative or Legal Representable)
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify:
tf pulverization of crerneted remains is requested.check here X
Revision:April 18,2W7