Spiezio, James d .
TO`l W OF QUEENSBUR9c
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director/'L �/�/N 6�Q�
Name VM S 5/6'/4-1Z,J Case # /f 1/
Date of Cremation " 3 / ` cRcX,
Time Cremation Started/97/ 33'?/ //
Time Cremation Comoleted Zit 30 F//1/1 r
Type of Container S77//f/d//r/Y GQC/V c2AfatCd./9,5 d/ 77/4
Remarks :
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 (if no answer)
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject
to its Rules and Regulations to cremate the remains of:
James Louis Spiezio Male
(NAME) (SEX)
Maplewood Manor Nursing Home Ballston Spa, NY 12020
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 30th day of July 20 01
at Saratoga Hospital Church Street Saratoga Springs, NY
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Margaret Spiezio Rt 29 Schuylerville, NY
Relationship to deceased Wife
Name of Funeral Home Flynn Bros. , Inc. — Schuylerville, NY
IMPORTANT AI represent that to the best of my knowledge, the deceased has o(as no)acemaker in his or her
body. (CIRCLE ONE) T I!
I certify that I have the full power and authorization to arrange for the cremation of the remains and
to direct the disposition of the cremated remains, that any personal possessions have either l =".g
removed or may be destroyed, and agree to protect, defend and save harmless Pine View
Crematorium from any and all claims and demands for loss or damages which may be made
against them by ason of or connec d with the cremation of said remains as directed, whether
c lai not wholly groundless, false or fraudulent.
13 Gates Ave. Schuylerville, NY 12871
WITN S) (ADDRESS)
- c. Route 29 Schuylerville,NY 12371
(SIGNATURE OF RELATIVE R LEGAL REP. AND ADDRESS)
Signed on this date: // G`