Goodell, Enoch t
70�� OF.- QUEEN5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
NamehocL u(1�or - CD�Gt{I Case #
Date of Cremation IS
Time Cremation Started
Time Cremation Completed
Type of Container Oct I
Remarks :
MAIN `� U M -M 01i
Town of Qugensbury
Pine View CoMeWy and Cremsodum
21 Quaker Road,4ueernsbury, New York, 12MM
Cemetery Office: (518) 745-4476, Crematorium: (518)745-4477 '
Audmization to Cremate
The undersigned requests and eullux1ims Pk*View CreMelarMtm,In aoaorderm with and au*a to Its Rubs and Regufatkxm to
crenate the rem eft of:
CVIOLIl MtcktoL (0v►v�0✓- ljcic�c� �
fl o 66' h"') nd Ld- Z0 GGVISe 0/0�-1�� n� 1 ZJ31
cam) / ter) ( ) (Zip Cade) -}1
who died on �` day of
at (w ('tV'Ns FtA I(, l�sn
cam) )
r+tame arrd address rd nemreat YYirp rrtlattrre yr tweme of auUwri�fip aerraw>giorw: �''
v✓Iol-� tul_�i �w ��� t Z� Qu �u.�✓ �v� ��Uh t e, �-�� �Y `Z3� s
(Name) vWdress)
RelelioroNp to V wt decoosed i^'�f'��✓ IT
F?
t r
Name d t�unerel ttbrrre U✓I i �'°►� /'LLB tK+C (���+ �vr
c-
IMPORTANT:
t nwrewd that to the beat of my kwwletlp,to vooaamd(w)or{twee no)peaerndw,deAbraOW,bawy,bmttery per.Power
Dell,r�edloective irnptent car ra tecttve devise k1 hfe or her body.(Ck0v Un®)
i csr"that I twn AM power mid mXho iaedDn m srrango for the avmo o of the remmkns end to direct the disposition of the r
Pine VViiew"��aand all dslrna aunt#dew wWs ibn or �•and apnea to protect,d*%4 and
so"hwmlim darttages wfwich msy be trade apaind them
by Of -%.*A F Ie i*W 00 cnwmdm of ward romans as diiwftd./whe dw st ch dein or denoxt are or am not wtxwAy
tabs
( mitt Address or or t deaf ertatl,re)
C
4
Signed on this date: _— vp-4— , _ T _—z ev
S
Dbpcasllfon of Ow mted Bins
I hereby dkted Pk*Vkw arm to depose of the eamuosd mialre as followw. 4
`q
Mall to
0Uw*teragemwft-t;'ksarra We*-,
If pulveftlion of crerrwatmd nemtalt s Is reed,tom:here
I:tevlsion:April 19,2DO7