Linke, Richard own v ueew "T.
ritlE VIEW CEMCTERY and CREMATORIUM
QIIAKFR ROAD, QUEENSQURY, NEW YORK 12801
(518) 798 472G
(518) 793-9777
Funeral Dirictor C_a+LerotO
tl.�mp l��`ch and I.. i AkG Case No. —
UaLe aE Cremation
Tints Cremation Started _
Time Cremation Completed , Set
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TOWN OF QUEENSBURY s
PINE VIEW CEMETERY
do
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
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:
•
Richard Adolph Linke Male
(Name) (Sex)
Pleasant Valley Infirmary, Argyle , NY
(Street) (City) (State) (Zip Code)
who died on 24th day of February 19 92
at Pleasant Valley Infirmary, Argyle , New York
(Place) (Address) ——
Name and address of nearest living relative or name of person authorizing cremation:
Mrs . Margaret Bailey, 348 Terra -e Ave . , Honesdale , Pa 18431
(Name) (Address)
Relationship to the deceased Daughter
Name of the funeral home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or as 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.
NO /
(Witness) 271 it •7,70 /
(Si ature off` Relative or23 -t-Ca-y al Rep.)
348 Terrace Ave .
Honesdale , Pa. 18431
(Address) (Address)
Signed on this date "Z/,sj/yam