Croissant, Michael Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Michael Croissant
were cremated on October 27 20 21 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death October , 25 20 21 Age 70
(Month) (Day)
Funeral Home Alexander Funeral Home Registered No. 891
Z•-•
(Authorized Signature)
CROISSANT
NAME Michael Croissant Age: 70 LF'
:F).
Lot Owner: Robin Croissant
Lot# Erie 77J Grave# 1
Case: Urn
Died: 1 0.2 5.21 Interred: 5. 1 8.2 2
Funeral Home: Alexander FH
Cemetery: Pine VIew
Owner
Robin C�c'�►SSQ,n
Address Plot
266D Burke Dr. Oueenshnry, Ny 12804 Erie
Phone # Lot #
5A-8-=4094998 os l 77J
Deed # Date
4289 10.27.21
Cost Foundation Y - N
$650.00
Location West-Greenholtz
East-Vacant
Norht-Haanen
South-Ferrone
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE':" D G DATE: lO/27 /
SIGNATURE: DATE:
Record of Interments
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