Drake, Billy rl-Oq4N OF QUEEVBUir�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
1
Funeral Director_/ AT it to;,�
Name I Dt-4keCase # 21 [
Date of Cremation U(tt
Time Cremation Started 20 Ph
Time Cremation Complet d 3' �S P
Type of Container
Remarks :
►tvE 21 PFi
2 :qo PIS
7�-
3i��Ph
� 211
Town of Queensbury
Pine View Cemetrary and C romakNium
21 Quaker Road,Queensbury, New Y^ 12M
Cermte fy Office: (518)7454476, Crerrtatorium: (518)745-4477
Audwdza*m to Cremate
The
undersigned m""and a gutm P'km View C mma oo",in aaaordanoe wkh and*Mod to Its Ruses and RWJWkww to
emnwe the r+eeneikne af:
m \A-A o-`>` ':-Or�-
(S`treet) { { } (Zip Code)
who died on day d _ 20
at (Dace) t
Noma and Nuke"of nest vvbv to a or Perna of penhon&Ahwisfnv awrnafion:
1 O IQo e
dame} (Addrem)
Ratetit WV 10 me dere9o"d on -
Name of Funeral Home S 0j te /1 C��y►e ✓ TTo m P •1�
IMPORTANT:
i m9nment#*to the beet of my lerowiedge,to doavesed(has)or gm nu)peaem 0w,deftNeW,betivy,be fty Peck.power
c o,rnsd8oecxive Wnpla t or raooective device k1 his or her body.(Ckde one)
I oar*slat I twm iue power end aut%Wbstlon 10 snunge for the tremedon of ulna remains end to dtr®cx the diepoebm of rie
cremated temoirm 00 sent'pere0n0l Pew hm*Mint been removed or may be deshoyed,and aprae to protect,defend and
sere madecoWntitilmn
oforconrmc*dwNhftcrrwna ion of mm roman d�edR wtwtl�rAii �suc��1 or d�amanadsimgmuldd tare ar art
h*m or
} (Addrtw)
eruct Address or Uvel R ive)
Signed on this 15 - 1
Qfsposkim d C rernsted Rem k*
I hweby ftec:t Pine view Crennator m to diepoae of the awnneted meal s as tKows:
MON to
otterarrWq merne-
tf Nhwhotion of awned mwoom is r>Weeted,dvKk hems
RevW rt:April 19,2007