Facey, John L. Pine View Cemetery & Crematorium
Quaker Road
Queensbury, NY 12804
(518) 745-4477 Or (518) 745.4476
FUNERAL MORE; �[ _Q ,S RETURN TIME:
DATE E TIME REMAINS ARRIVED AT CREMATORY: _ 1)D)jp it,,,Oph
NAME OF FUNERAL DIRECTOR OR REGRISTERED RESIDENT DELIVERING REMAINS:
NAME: .Jbwo fm CY CASE
I0 DT
TYPE OF CONTAINER: PIRI10,.r- O AA!641 ofNSNj
PLACE OF DEATH: IBA Bhy trw qD{ 1('yqf & l0l
ESTIMATED WEIGHT OF REMAINS A CONTAINER qw Mr
PLACED IN HOLD:
PLACED IN REFRIGERATION:
DATE OF CREMATION: 7)D)70
TIME STARTED: PIE&I TIME COMPLETED: Q U. O AN
PLACED IN RETORT: _ x XNJ MOVED: IIYD/d1l 10� 16kn I )p;y
RETORT R IN WHICH REMAINS WERE CREMATED: fli A I%[( )4OW
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATED MORE THAN 45 HOURS �1'
FROM TIME OF ACCEPTED DELIVERY:
NOTE: THE CREMATION LOO FNLLL BE RETAINED IN THE PERMANENT FILE OF THE CREMATORY.
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