Troeber, Fannie Y
jown O ueenj ttr
rtr1E VIEW CEMCTERY arrd CREMATORIUM
QLJAKFR ROAD, QUEENSQURY, NEW YORK 12801
(518) 798 4 72G
(518) 79;3-9777
Funeral Dirictor
tl•,nie �r� / S /�i7/l�/y/ ��f�•��ic�'/r Case No.
Dale of Cremation
Timp Cremation Started -?,. 1AO r
Time Cremation Completed ��Aoly"In
1}'1 of Container 07, /1/tq
/a ,�
,/!/D C6ell� .fit)i(
i
i
i
i
i
i
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
&
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTHORIZATION TO CREMATE
'rhe undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
Fannie Lenore Troeber female
Name Sex
11 Bascom Dr. , Fort Edward, NY 12828
Street City State
Zip Code
who died on - 24 day of March 19 92
at Albany Medical Center, Albany, NY
Place Address ——
Name and address of nearest living relative or name of person authorizing cremation:
William H. Troeber, 11 Bascom Dr, Fort Edward, NY 12828
Name Address
Relationship to the deceased husband
Name of the funeral home
. �rlatnn FimPr 1 Hom , in
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has no pacemaker in his
or tier 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 b Vi w Crematorium, from any and all claims and demands for loss or damages which
may made against them by reason of, or connected with the cremation of said remains
as dir ted, whether such claims or demands are, or are not, wholly groundless, false or fraudulent. j
4
itne s Signature o Relat ve or Legal Rep.
68 Main St 11 Bascom dr
hudson Fa31s NY 12839 Fort Edward, NY 12828
Address Address
Signed on this date 3/26/92
i