Randolph, Clarence •
Town of Queensbury
op, Certification of Cremation
Pine View Cemetery and Crematory
This certifies that the remains of: Clarence Randolph
were cremated on November , 9 20 22 at the Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains of said body.
Date of Death November 6 20 22 Age 88
(Month) (Day)
Funeral Home Singleton Sullivan Potter Registered No. 876
(Authorized Signature)
RANDOLPH l
Owner LF
Helen Randolph
Address Plot
251 Chestnut Ridge Rd. Queensbury, NY 12804 Mohican
Phone # Lot #
518-793-6897 1 J
Deed # Date
4378 4.21 .23
Cost Foundation Y - N
XXX Swap Graves
Location
West-Batcher
East-Mosher
South-Road
North-Law
Remarks
I ACKNOWLEDGE THE RECEIPT OF THE RULES AND REGULATIONS OF THE
PINE VIEW CEMETERY:
SIGNATURE: DATE:
SIGNATURE: DATE:
Record of Interments
rJoO 11 le- 6
1 C p - -
2 7
3 8
4 9
5 10
.BATC NF
1s
° )14
Mao=44 ► -.
Randolph LF NAME Clarence Randolph ge: 88
Lot Owner: Helen Randolph
Lot# Mohican 1 J Grave# 1
Case: Urn
Died: 1 1 .6.2 2 Interred: 6.2.2 3
Funeral Home: Singleton Sullivan Potter
Cemetery: Pine View