Simmons, Charles a
Town of Queensbury
Certification of Cremation
Pine View Cemetery and Crematory
•
This certifies that the remains of: Charles Simmons
were cremated on January , 19 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury,New York, and these are the cremated remains of said body.
Date of Death January , 17 20 22 Age 86
(Month) (Day)
Funeral Home M.B. Kilmer Funeral Home Registered No. 58
Zit
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(Authorized Signature)
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SIMMONS
NAME 1
Charles Simmons Age' 58
Lot Owner: Family Plot
Lot# Family Plot Grave#
Case: Urn
Died: 1 /1 7/2 2 Interred: 8/5/2 2
Funeral Home: M.B Kilmer Fh
Cemetery: Friends Cemetery