Ferguson, William A • TO TON OF Q QUEENSBURT
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Name
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Date of Cremation deb lL 2010
Time Cremation Started
Time Cremation Completed 10 . 304h
Type of Container (c„cLrcl pc).417 Rik' f
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Remarks :
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E2/22/2020 1.2:2E, 518-793-3E41 SINGLETON/SULLIVAN PAGE. 4 )Town of Ousensbury
Pine View Cereelesy end CrerttlitOrILIM
21 Quaker Rood,QuestoSbUty,New York, 12804
Cemetery Office: (516)745-4476,Crernetodum: (518)745.4477
AUMorlesflon so Creosote
The astaragnstt rapes,tad oratorical Pine Vies Cionalodum.in aOtordetm•slat end eid/Pri%to tic("Woo and Relloilltionsio
Onnesee the means at
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Moos) (Address)
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Name and*Waft le nearest kap Main or nem of wan eutharlidno cremation:
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eeteepreeop esi deceased r-
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Name of PUnerei Heine 1 oteis
IMPORTANT:
I represent that to tie beet of toy loarMedge,the decasSed(W) (hogceillrtetter.dentblattdr.Mary,Oretroy fork vow
It.redlosolive ifropient hr reditszans dodo, h is Or herby,(
OM* NW AA WOW and etahoittettoo to strange for ins melon of tno refrains end to direct the din of the
Crabeted Musa*that any peace*pOsSeesans hews stew bean wooed sr may be deerayed,end owes tra mart deism ene.
sane nannies,Pine Vies Cremettulten frori any and as chains and demands for bee or darnegpse*OM may to recto*One them
by meson of cr connected with the creamer:of said Ismail*as dincilect.stather such ebans or detente Ms Or we not Weir
grourdess,*Me asfratedulans
CAddress)
and Address ei Relative or L
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Disposition or Cremated Remains
I*sway eked Pine Viewer to dispose Of Ms Crenated rerneine eV Woes:
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Other errirspentente-Moss aposey:
Lf putitorkesSon cA cremated woes broweated,check here
sosriralorc awayI.200e
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