Eccleston, Doris TOWN OF QUEEVBU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
�y
Name All25; 06'f1St �f�,CA-'--S7c-W Case
Date of Cremat i on/j"-I-� —/�L
Time Cremation Started /f140 �//yl t
Time Cremation Completed_ 7l
Type of Container 7 C ?5-,-- djf 7f/.E-JJJJjp1/
Remarks :
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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
AUTUORIZATION TO CREMATE
,he undersigned requests and authorizes Pine View Crematorium, in accordance with and
subject to its Rules and Regulations to cremate the remains of:
N Doris Elizabeth Eccleston Female
ame
Sex
27 Bur o ne Ave. , A t. 11 Hudson Falls, NY 12839
Street City State
Zip Code
who died on 22nd
. day of Dec. 1992
at Glens Falls Hospital, Glens Falls, NY
Place Address ——
Name and address of nearest living relative or name of person authorizing cremations
Alan H. Eccleston, 27 Burgoyne Ave. , Hudson Falls NY 12839
Name Address ,
Relationship to the deceased Husband
Name of the funeral home Carleton Funeral Home, Inc.
IMPORTANT: \
I represent that to the best of my knowledge, the deceased has or s�nopacemaker i 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 o fraudulent.
Witness
68 Main St. , P.O. Box 67 S gnatu e o t ve or Legal Rep.
Hudson Falls, NY 12839 27 Burgoyne Ave. , Apt. 11
Address Hudson Falls NY 12839
Address
Signed on this date l ?��2� C4 L/
TOWN OF QUEEN3BURY
PINE VIEW CEMETERY
do
CREMATORIUM
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 oft
Na-ley Sex
Street City State
Zip Code
who died on day of 19
at
Place Address ——
Name and address of nearest living relative or name of person authorizing cremation:
Name Address
Relationship to the deceased
Name of the funeral home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has 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.
Witness Signature ol Relative yr Legal Rep.
Address
Address
Signed on this (late