Schultz, William A. Pine View Cemetery g Crematorium
Quaker Road
Queens bury, NY 12884
(518) 745-4477 or (518) 745.4476
FIINERgL HOME:
DATE B TIM "-- -- RETURN TIME:E REMAIN$ ARRIVED AT CREMATORY:NAME OF FUNERAL DIRECTOR OR REGRISTERED
RESIDENT oEUVERIN6 REMAINS:
L�_�ESI Xq$
TYPE OF CONTAINER: CpbC $ —�
B=LkI_PLACE OF DEATH: -__ 3 ,Sy ��4r- 4� 1� `=I�•�
ESTIMATED w —_.___._.._.
EIGHT OF REMAINS $ CONTAMER___ 7 PLACED IN HOLD: _ — TW / (o�
PLACED IN REFRIGCRgTIDN:
DATE OF CREMATION; _
TIME STARTED: ._ � N $ID ITD
PLACED IN RETORT: —�—TIME COMPLETION
IO:fD ' yD _
RETORT p IN WHICH -- MOVED: -- _ /� •�.p�
REMAINS WERE CREMATED: LL(�CV�'JLp'RT�,
DETAILED REASON FOR DELAY IF REMAINS WERE CREMATE ,I
FROM TIME OF ACCEPTED DELIVERY; AN VS HOURS
_
NOTE: THE CREMATION L00 SHALL BE RETAINED IN THE YtRMRNENT FILE OF THE CREMATORY.
JVVrlF=
=',WRK Division of
Cemeteries
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