Frank, Vera T074N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name /1 Case # c�
Date of Cremation
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Time Cremation Started i�_ i 7
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Time Cremation Completed
Type of Container
Remarks :
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TOWN OF QUEENSBURY `10
PINE VIEW CEMETERY
/�
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or 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;
Vera A. Frank FiQma 1 Q
(Name) (Sex)
Wesley H _a1 t Care G nter 4 ram-- w�a � r Vnrk� 1 7RF,r,
(Street )
(City) (State) (Zip Code)
who died on 29 day of November _ 19 94
at Wesley Health Care Center, Saratoga Sprinas,Ny, 1866
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Loraine Brandt , 660 East Capital Blvd ,Salt Lake Citv,Utah, 84103
(Name) (Address)
Relationship to the deceased Daughter
Name of Funeral Home William J . Burke & Sons Funeral How.
IMPORTANT:
I re .resent that to the best of my knowledge, the deceased has or
ha no pacemaker in his or her body. (Circle One)
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
been 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
reason of or, connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
groundless, false or fraudulent.
de / 628 North Broadway, Saratoga Sprq,Ny, 12866
(Witness) (Address)
660 East Ca ital Bivd,Salt Lake Cit Utah
(Signature of Relative or Legal Rep. and Address)
Signed on this datesNovem_apr 3fl, 1Q9a