Roberts, Allana 4
OF- QUEE*BUr�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW Y.ORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name � 5
h, u
Case #_�j ��—
Date of Cremation (�c 66r s-
OQ
Time Cremation Started
Time Cremation Completed `
Type of Container �r
��� U —
Remarks :
au
O- L U
COO L
i0!01`2009 13: 11 5183254132 OATH LAB
PAGE 02
3,2: .35 518-753.-.364� S
NGLE?CfJ/S�:LL_tr p.i ,'2 .1
Town of Qtueensbtuy
PIAO Mww Cern*"and Cremoutarium
21 4u9ker ROOd.0~11bury, New York. 12804
Cennatery O face:(518) 74&4476, CrwuMcwium:(518) 745-44-n'
Aubxwksb in to Crurnaale
T►»411ders19nad regwaw end sLavriwrs Pine L°isw Cf+gtsfaiutn,M
oror wda Do rematna of ae+nordsrtce with sae subod to Its Rinse and R9puiat Orw ea
(Stec)
(Zip Gods)
who dieei on 1r' dby CO
NentwM� srtd dd r/�err�Mig rolWva ar nom*0/p0ma c m4horkft Ow,40m;
J
Remit!to fnt<ds=*"d
Mama of Funarei Hans
IMPORTANT:
i 1ep►"sor!t!f►at to the treed Of my btawiedpa,UtY daeearaq(has)or l n+ekar,►ft d0f[Wflanor,better3',butWy f ,Pam'
c9k Mdloaclive or rsdN� mwe dsvim inar hw body,(, ne)
I M1111Y tfwt i hove 1VM Paww end aww b tw to wrrsttoa for t►ts cxrrrnaAM of fhs rsmakw and to direct thea%rn*W ramatrts,!*trot any pwxe"W Poaasaaim"here siHnar ttsstt rarttcwed of Rwy p`e,to o,fhq
sows ffarnNss,tNits t11sNr dRrrtNndR fpr bee<yr ' be r
end mpn►s to PtMCL d&*Yd end
Cry nteowkn hom !y and at cisinw Md
by reeaen of or oonrnctod with#w c�wnstion of MW n wwkw .dr d +ay+er r nara Imr or ttwm
grw, tdaetx
(Somme aida R tiveL or Lagei tv�
steed on!hie dots:
t)}spasMfan of Cromatttrd Rwfla is
I iw"dkeof Pbts View cmntrfmkrm to dlepgss oaf ft Crarne!lad rrr+rttttNut aw Ulu":
Me"to
Othw srrtutp wwtts-pltnasa*OWN;
N PAMIW=atbat of a vrmned eanrabw is mquettfed,check hone
Ftavisbn:.16ncAWy 1,2OW