Bernes, Grace 41111111111114 TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
r 21 Quaker Road, Queensbury, NY. 12804-5902
(518) 745-4476 (518) 745.4477
http://ww v.qucensbury net
Funeral Director:
Name of Deceased: Cs'k c-t_ 13 F-R. pie 5
Case Number: Li cc-
Date of Cremation: I I - -t—o o `.s
Retort: ftc
Time Cremation Started: 1 l 1 0 Pc
Time Cremation Completed: 1 14 5 P t/vL
Type of Container: 014 t7 3€ I I irAwd zwp 34C N f 5� 14—t-�
Remarks:
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