Newman, Mary TO` V-A� OF UEE
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745.4476 (518) 745-4477
f4Grl Funeral Director '
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Fame n.
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Date Of Cremation
Time Cremation Started
Time Cremation Completed 3" j p
r
Type of Container
TSyi r� nc.� L Sf
Remarks —
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Town of Queensbtmy
Pine View Cemetery and Crematorium
21 Quaker Road,Ckieensbury,New York, 12804
Cem lery Office.(518)7454476,Crematorium:(518)7454477
Auttl wizatic>st to Cremate
The urderj0red rewaata and audrortws Pine View Crematoraan,in eaoordanoe with and etsts W to its Rules mid ReWleHons to
gemate the restrains of
Mary Frances (Eastman) Newman F
{Name} (Sex}
Eden Park Health CGiengaifalls NY 12801-
(S"W) (W ( ) (Zip Code)
who died on 30th dayof Januar 20 07
at Glens Falls Hospital Glens Falls NY
(Ptaas) (,oddrass)
Name and aftew of nearest Wing releeve or name of person sWwrb*V crersms m
Anne Haag 19 Robin's Run
(Nam) (,Aditss)
Daughter
R+datiorrstrip to the dex>Hemad
Nam ofFunentNane Carleton Funeral Home, Inc. T_
IMPORTANT:
1 represent that to the befit of mY luiowiedge.the deoee sed(has)or oo) falser,defisrtNator a any otlrer
a�nriae in his cx her body. {Girds One)
1 certify thou t have UA power and auu0mrtzation to artenge br the crerruatiae of the remains and to dkW the dtspoeidon of the
cremeWd nwnehs,that emir paaanal possgswm hwe etcher bean removal or MY be destroyed,and spree 10 W016 ,detarrd and
sees harmless Pine View Crunsimium from any and aM dain and dwraatds for bn or derrragm vA*h may be made agako Imm
by reErgon of or connKled wkb the rssmakm of seid rearefne as dr+eded,wtvWw auch dWm or demands we or are not wholly
isles or fr+audufarl.
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(1M1iRrreusa} (Ad&m)
X �i u�� S c ���,,�I- , ✓I 4
{ nattse and of Relat n or Legef RepreeW906")
Signed on this dare: I 1 31 / 0
pispoaation of Cremated Remmers
I hereby dined Nine View C"srreWMWn b dlspos'a of the cremOted reMainS 88 follows:
Mef to
Other .errangement s-Pleese spedfr.
if ptdvargoom el asmaeed cmnains is rsQu904 dvxk here XX
Revision:J&suary 1,2006