Stewart, Virginia 97'o4N of QUEEVBU9�
PIN PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director r_ARE I
Name (J I �� 1 }�/ Ir14 eiJLUZa j2 Case #
Date of Cremation —Cf 2
Time Cremation Started 10 - 36 A , Yh �
Time Cremation Completed
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Type of Container cTh
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Remarks :
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TOWN OF OUEEN94URY
PINE VIEW CEMETERY
i
CREMATORIUM
I udker Goad, L1ues..sbury, New York 12804
15homo ('S18) Crematorium 7415-4477 or if no answer
Cemetery 745-4416
FIUTHORIIATION TO CR4MATE
The undersigned wequests and authoriites Pins View Crematorium, in
accordsrire with and subject to its Pules and Regulations to
cremate the remains ofi
VIRGINIA T . STEWART FEMALE __,...
(Name) (BON )
12 JASPER ST . , HUDSON FALLS , N . Y . 12839
(Otrett ) (City>. yT� (9J---ty� tZip�Ctlde)
who died en 41H day or JUNE 19 93
at PLEASANT VALLEY 1NF1nM4SV , ARGYLE , N . Y .
(Plats) (Address)
Name Slid address of nrare■t living relative or name of pow-son
authorixinq cremation #
MARY,. ANNE SCNEELE , 645 CALEDONIA RD . , DIX HILL , N . Y . 11746
(Address)
Relatiohship to the deceased ...._ NIECE
Name of Funeral Home CARLFTON FUNFRAL HOME , iNC . y ,TT_
IMPORTANTe
I re resent that to the best of nay knawtedoo, the deceased has or
has r,u pacemaker in his er her body. (Circle One) NO
I certify that I have the full power and authorixation to arrange
for the rremLtlon of the reihaitts and to direct the disposition of
the cremated remainst that any persenal possessions have either
born r-w*oywd br May be destroyed, and agr-** tv protoett defend
and save harmless pine View Crematorium from any and ail claims
and demands for loss or damages which may be made against them by
reason of or connected with the cremation of said remoins as
directed( whether such claims or demands are or ors not wholly
Around ss, fals or fraudul*nt,
68 MAIN ST . , HUDSON FALLS , N . Y , .-
(Address)
645 CALEDONIA MD . , DIX HILL , N . Y . 11746
�111qnoturw of Relative or legal RsP. and Rddress)
Signed on thie datei JUNE 6 , 1903
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