Wertheim, Helen r7l I rNIN OF
QUEE%5B U�zy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW Y,ORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 13a-
Name �� ) r}I �I
�Ith "" , h Case 1l
Date of Cremation
Time Cremation Started �i00
Time Cremation Completed
Type of ContainerC�ZA w r f. S
Remarks ;
ANSO A4
to :z0 Pti
1 :o"
J
a
Town of Oueensbury
Flrte View Cemetery and CmmatiAm
21 Qualm Road.Queertsbury.New York, 128M
Cemetery 081=(518)745-4475,CrenwWdum:(518)745-4477
A dhorizoAion m Cremate
The undwWorwd nsquesls and eutlrodt Pins Vhwv Q sffwwd sn.In ac os vAh and subject fo Its Rules and Repuledons b
Crairlate the renlWoof
(ftw) cs�
e)�ci rTLn ti�-rst n c N�n, ecnshu( ) 1\\-1
(sue tin►) Cam)
who dies on dalr of 01 M
Name and addiees of nsorest fain0 teiaWe a Herne d parson ar�rorizkp demetiorr
RUM) (Address)
Reiatlond�ipblhedeoaaeed-1'T � �n�l � I'(�
Now of Fursrd F♦W*te {Z iA P 1' 1�Z� Y `A C
IMPORTANT:
I repeeett UreR b 1f rs beet d rrry lerorrler4s,firs or Ares no)peoernairer.delbrielor.baUary.bagarr pwk Pow
r ostl,nsdloactlns i a or redbacfine dwbe in hie a her .(CYebe One)
1 cerflti►llret I hwe ir/power and autirorlsalbn b arrerrps for the NOR of the I' l kts and b dkect ere t"Neon Of*
erenrefsd rerrrakrs.tlrat anp pweorrd possseskrns hone eMrer bean rernwed or mW tm dsslrog I and ease to poled dafari and
Pine Visor daaraforlum tiOla anirend a/tieirrrs and derrrertds IN foss or dsnnpes wtdch melt be made apskret them
by of arcorara fed rrt the cremeeon d said rerlrabs as drecisd.whaewr audf clans or damerrda are a are not whoNy
ar tterJdlAwt
•
(Soak"slI g
nd Addre�scFI%M re cr UVd PAprssw t *m)
th
Strad an is do* I� � �
DlspoWw of Cremated Rem A
1 hereby dkact Pine Vkw Cmwm* km to depose of dre aerrreled reetakrs es follows
Maio
oew affwwr r ft-Please 061 a rKI
If puinarbadon d cremated remakes Is requssled.check hers ._
RwAsi rc Apdi 18.2W?