Martinez, Dennis H105.111 REV.4/06 COMMONWEALTH OF PENNSYLVANIA � .
DEPARTMENT OF HEALTH
VITAL RECORDS
RECORD FOR INTERMENT OF CREMATED REMAINS
Full Name of Decedent Dennis Martinez ID# C0737
Sex Male Race Caucasian Age 67 Cause of Death Glioblastoma
Place of Death Rapho Township-Lancaster County Date of Death 4/27/2022 Date of Birth 10/15/1954
Township,Borough or City—County
Name and Address Pine View Cemetery
of Person to Whom Name
Remains are Given 21 Quaker Road, Queensbury, NY. 12804
Address
Name of Crematory Charles F. Snyder Jr. Funeral Home & Crematory
Address of Crematory 3110 Lititz Pike, Lititz, Pennsylvania 17543
May 2, 2022 44..u"i It- /JrA-�- •
Date of Cremation Signature of Cre atory Official
This record will be completed by a crematory official in all cases where cremated remains are to be interred in a cemetery.It will be attached in an envelope to the outside of the
receptacle containing the remains,but inside the shipping wrapper if any,and be retained by the cemetery as part of its records.
MARTINEZ NAME Dennis Martinez CI:If) Age: 67
Lot Owner: Jordan & Nisa Martinez
Lot# Huron 20K Grave# 1
Case: Urn
Died: 4 .2 7.2 2 Interred:5. 6.2 2
Funeral Home: Regan Denny Staf ford
Cemetery: Pine View