Granger, Adelbert 5ouln v ueeni " .
ritlE VIEW CEMCTERY nd CREMATORIUM
QLIAKFR ROAD. QUEENSDURY, NEW YORK 12801
(518) 798 4 72G
(518) 793-9777
Funeral Dirictor
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UaLe of Cremation 6 ` 9�
'I'inr Cremation Started r
Time Cremation Completed 41 "
'I}pe of Container
tic►►ti,r P s _ l d/`nf �3cJf?�t/ �� �6 �';41
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
r•'
CREMATORIUM
1
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTIIORIZATION 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:
Adelbert L . Granger male
Name Sex
Hartman Road , Town of Kingsbury , New York 12839
Street City State Zip Code
who died on 24 th day of June 19 92
at Hartman Road , Town of Kingsbury, NY
_'lace Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Stephanie Alexander , Rock City Road, Hudson Falls , NY 12839
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 A"acemaker in his
or her body. (CIRCLE ONE)
I certify that 1 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
a dir cted, whether such claims or demands are, or are not, wholly groundless, false or fraudulent.
u/ . x"4 \/� ___5,hAA4,?
Witness Signature o Relat ve or Legal Rep.
Carleton FLrneral Home , Inc . Hudson Falls NY
Address Address
Signed on this (late ..� �,lac