Slavin, Edna May 50tun O Gceenj
f urN -
itlE VIEW CCNICTERY and CREMATORIUM UU
QIiAKFR ROAD, QUEENSQURY, NEW YORK 12801
(518) 798 4 726
(518) 79:3-9777
Funeral Dirictor
t l•�m!? Case No. c>L $�
Dale of Cremation �a 9
Tints Cremation started r,3 y rQ�/y� +
Ti me Creakit ion Completed �p2,�Q� �` /Y► +
1�1 of Containers )0:W/
1Y1�211.E�1� Any
y A ,M
zz
J 3a �9�M
1AV& Cam D6 CJ nl
TOWN OF QUEENSBURY
PINE VIEW CEMETERY % �p° --
& .
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777
AUTIiORIZATION TO CREMATE
'fhe undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
Edna May Slavin
No ney female
Sex
20 Dix Ave, Glens Falls , NY 12801
Street City State
Zip Code
who died on 22nd day of September . 19 92
at Qjpng falls Hos it al , Glens falls , NY 12801
Place Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Patricia J, Slavin
Name Address
Relationship to the deceased
-I-ucfhter
Name of the funeral home Carleton Funera
IMPORTANT:
I represent that to the best of my knowledge, the deceased has o hDnoacemaker in his
or her body. (CIRCLE ONE)
1 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 njnde against them by reason of, or connected with the cremation of said remains
as direc d, whether such claims or demands are, or are not, wholly groundless, false or fraudulent.
L
fitness Signature o Legal Rep.
68 Main St Relat ve or
Hudson Falls , NY 12839 20 Dix Ave, Glens falls, NY 12801
(Addressi
Address
Signed on this date
Pulverize and call when ready