LaClair, Brian rO q+N OF QUEEVBU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director +a�,,.\
Name �Ne, `aCf���. Case # 3l1
Date of Cremation V u�l
Time Cremation Started Vos Ad
Time Cremation Completed Ib� iO
II
Type of Container F a v,er c tL{25T Gfl
Remarks :
f�uv�
V z 3
ib ' lUA 4?
31>
Tom of Queertsbury
Pine View Ce ff*Wy and Cremaitxdum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518) 7454476, Crematodum, (518)745•4477
Audxxtmt3on to Cremate:
The ur4 soW mqtmft and aulhnrfm Pkm view Ownekni m,In aomordarm with Arad sabd to fts Rules and Re *Klorm to
Ctentate the mtm is of:
Brian L. LaClair male
(foam) (Sex)
9 Henry St. , South Glens Falls, NY 12803
( ) (CRY) ( ) (Zip Cam)
who died on 17th day July 2009
at 9 Henry St. , South Glens falls
(Piacst) (Addt m)
AlWO and W**VA8 d rOarast Yvinp MINN*or morns of person atuttwdmkV awral m;
Traci Reynolds 6 Fuller Rd. , S . Glens falls, Ny
(Nauss) (Adckess)
Rip to thedoomaed daughter
NanteolPwmalHome Carleton Funeral Home, inc.
IMPORTANT:
I represent that to fi'ta boat of my bvwWW,the deow*W{has)or(hm no)plc. maker,deOxNamr,t omy,befty Peck,power
aaeM,redoecfte kt>pWI or reftec Om device In hie or her body.(Girds One)
I ow*that I hom AA power end rjdx rbn*m to ar=W tar#0 arernedor►of the mumirm and to dked the dWpoeelm of to
awnsted remelns,that awry persond poseesdons have e0 m,been removed or may be deshioyed,and apnea to protect,derend and
save ham ma a Pkm View C mmeiorim kom tiny erd A rim!rrts and deaterds*x io®m or dmnages wWh may be made apWnet Vmm
by d a c wwmc od dw aametion d said mrn km as dkwWd,whelps wch Geirns or dmim sire or ere rat Way
t'dsaa or irattdt�at.
3
rleton Funeral home, Inc.
(V tit ww) (Address)
,as above
we Addmem of ti,eiatiam or teW RepreeerW9W e)
SOW an#*dote: (I I I f) l o9 --
Dbposkim of C renm ed Remmirts
I hereby dWw Pkv view Crenm orkn to dbpoee of the cxersaetetf mmaks as tflowr.
Mali to
Ottaer army etsrer"-PIee a epecWr.
tf ptd wketion o,cremated mmakts is requested,dyer k here
RevW rr:ApFV 18,2007