Hough, Norman E. Sr. 7otVl'b U ueeno ar
y.
ritlE VIEW CEMETERY and CREMATORIUM
QL►AKFR ROAD, QUEENSDURY, NEW YORK 12801
(518) 798 4 726
(518) 793-9777
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TOWN OFRUE Y
PINE VIEW CEMETERY
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CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTIIORIZATION 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:
Norman E . Hough , Sr .
Name Sex
Main St . , Middle Granville , NY 12849
Street City State Zip Code
who (lied on Friday 26th day of June 19 92
at Glens Falls , Hospital , Glens Falls , New York
Place Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Mrs . Kathleen Hough , Main St . , Middle Granville , NY 12849
Name Address
Relationship to the deceased Wife
Name of the funeral home Carleton Funeral Home , Inc .
IMPORTANT:
I represent that to the best of my knowledge, the deceased has o has no acemaker 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 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.
Witness Signature o Relat ve or Le al Re C . Bruce Wetmore p.
68 Main at . P . O . Box 292
Address Mi r nville NY 12849
Hudson Falls , NY 12839 Address
Signed on this (late June 27 . 1992