Armstrong, William T07+N OF- QUEE BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW YORK 12804
(518) 745-4476 (518) 745-4477
I_) Funeral Director
Name "" � �
Case # ysa
Date of Cremation 06,6r 11 Z6o5
Time Cremation Started I;S'S # �
Time Cremation Completed
Type of Container
r c�S
Remarks :
pU� 5,00 r4�
Ct-'a/3 f1
Town of Qu eensbury
Pima View CemeWy and CremsWum
21 Quaker Road,Quee nsbury, New York, 12804
Cemetery Ofk*. (518) 746 4476,Crematodurn: (518)745-4477
Autft AmPon to Cremate
The undersigned regtsse m and at*aim Pine View asmatarlum,In aotaordanoe with snd a toed to its Ruffs and RMftlwrs to
tx Wma the mrtW"ot:
William Bruce Armstrong male
(N") ( )
3 Empire Ave. , Glens Falls, NY 12801
(Street) (CRY) (5IGte) (ZIP Cade)
who died on 22nd day of October 20 09
at 3 Empire Avenue, Glens falls , NY
(1311900) (Address)
Name and address of rwarest y,r q rehm v6 or game of per VW SLOW *V cremation:
Joanne Armstrong 123 Crandall St. , Glens falls, NY
(Name) (Adds)
s9ouse
RekffiomW i0 ft dEeCessed
Namedt=u.,4Home Carleton Funeral Home, inc.
IMPORTANT:
I represent ttwt to the beat of my W wi edge,to dooattoed(haa)or(tree no)pacemaker,deftiONtar,bettwy,bafty per,power
+ceN,mmacdve hy"er or racaecv"device in f b air her body_(Ck de One)
)
I eerft that I have RA power and audwFbn ion to snaRpe tar the asmakin of the remeft and ho dho the d1sposkion of the
arms@ ed rameine,drat any pereond poseessione have eilthar bam nw*ved or may be deshvpd,and spnae to protbet,dsfend and
save hen mee,Pine View Crs tralodm ftm my and aN risk i=W demmde W im or damages wTtkh may be made eg**Own
by Of theuamaWn of aaid rematra an dr+erlect,rMhethar such ckbrher or darrranrltr ere or arts not Uftly
tatae ar iatrduient.
-` Vcarton Funeral Home, inc.
( )
�, � • Glens falls , NY
(Sk"*j e and Addmsaiobf or Le" we)
777
Signed on this cbste:
Dbp ookiort d Crenxvted Remains
i hw eby direct Pine View Cremetodum to dispose of the camuoed wm*s as*Aows:
Mem to
giber avangemenm--t Pan apodry:
ff pu Nefta bn d Grand remains Is nxpestad.check hire
Revbkwr.ApF118,2ti07