Bulkley, Nancy TO TIN OF Q $ urRJ
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Rtcps Q„„
Name
kjcsvNci gul Ct Case # (A—
Date of Cremation Ft b ci , 7010
Time Cremation Started
Time Cremation Completed 1(Y 76
Type of Container �rr(buur CQAwt02O t Csyr
Remarks :
ilftrh c6: 3c J 1 tt1O VIo4
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Town or Qusenebury
Pins View Cemetery and Cre n.torfurn
2 t Quaker Road,Queensbury, New York,,120r14
Cet,rretery Ofcs.(518)745.447e cremate/Hum:(618)745.4 77
Auihossr.Yon td CremateThe undwattined
NM the requests lad eWKntz s Mite Vleiw Crememrturn,Oft a ttaf with and oubfeci to Rules end Rputettgn,to
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t •) (or,not 4_t ! 21a
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dmtr thLt kr 20.10
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H„reigend t►rhp Meese, rxt n t {
Jb { e, '�4�� r .-t hGt .
Fleislorrshle to Os wows, Mtvz.Se
NW.arrowel borne
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Sato the beet of my esssisdpe,the d mesa/(ham)or Ines rto)escerneUw,ertlbrastor. • ,hattetry reek MOW
trttylartt or r.dloRtere a.Moe to hie a her trod,,.(Otos One)
iI waycremated termingIwo full pow end siahor4zatbn to wrongs for the crsmsllon of the reaming end to Owl dleposgbn of,the
personal pomawebtN here senor bon removed or met be dellroyed,end se to proem,dMntl win
Itn we M View • from wry end en claims end Omer**toes or daneltee*sun De made meant than
raison' a r4 trw oetwro n of sett to/mottoes'.'arreeted,.tooter awl atlas or dome • ere or am not:wrgtty
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{itoneturs and «Lepel Ilsonl eert r r
Sped on this da. ,CJ 2o d O
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Otepoettran of Cremated Romaine
t wetly dUsct Pkte view Crsmetortum tat dlrpw of t e cremated morns es follows'
Moll to
Other Jreattemente•Mean spadty
' k
riptr}rertsstlon of%tattooed wrathy Is requested,check tie
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Rwlktn:Jemmy 1,200
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