Mangelsen, Magret 50tun O ueeni ary.
r'IPJE VIEW CEh1CTERY and CREMATORIUM
QUAKER ROAD, QUEENCQU►2Y, NEW YORK 12801
(518) 798.4 72G
(518) 793-9777 " 1
Funeral Dirictor ffQ�F 7Oiy
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UaLe of Cremation
1'inv, Cremation started LQ;Jg
Ti me Crermt ion Completed �a, s,P� ►
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY � l�C
do
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
a
AUTIIORIZATION TO CREMATE
,me undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
Magret E. Mangelsen Female
Nome Sex
Geer Rd. Hudson Falls, NY 12839
Street City State
Zip Code
who died on January 31 , 1992
day of 19
at Glens Falls Hospital , Glens Falls, NY
E'lace Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Miss Christel Mangelsen
Name Address
Relationship to the deceased Sist er
Name of the funeral home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has no pacemaker in his
or her body. (CIRCLE ONE)
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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.
J �
Witness
Signature o Relat ve or Legal ep. 2�
68 Main St.
RD Box 408
Address Address
Hudson Falls, NY 12839
Hudson Falls, NY
Signed on this date
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