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Jones, George Sr. z0%kN OF QUEEVBU.'kY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Directors 7C1/u Name (r ©�f U--,�� �SO/�is .J Case # Date of Cremation�7`-�? �7 _ Time Cremation Started f Time Cremation Completedq/®® , 9///7 i Type of Container �e �j3a�li'J ����/�.s�- 7`10f- Al Remarks : f IM zz ��r/ � a ` 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 AUTHORIZATION 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: (Na -ne Sex Street City State Zip Code who died on day of 19 at (Placei 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: 1 represent that to the best of my knowledge, the deceased has or has no pacemaker 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 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 of Relative or Legal Rep. Address (Add ess Signed on this (late TOWN OF QUEENSBURY PINE VIEW CEMETERY do CREMATORIUM Quaker Road, Rueensbury, New York 12804 Phone (518) Crematorium 798-4726 or if no answer Cemetery 793-9777 AUTHORIZATION 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: George E. Jones, Sr. male Name Sex 15 Gibson Ave. , Hudson Falls , NY 12839 Street %k'ItyyState Zip Code who died on 13th day of July 19 93 at '15 Gibson Ave. , Tn of Fort Edward, NY Place Address —— Name and address of nearest living relative or name of person authorizing cremations Mrs . Beryl Jones , 15 Gibson Ave. , Hudson Falls, NY Name Address Relationship to the deceased wife Name of the funeral home Carleton Funeral Home, Inc. IMPORTANT: 1 represent that to the best or my knowledge, the deceased has 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 di ted, whether such claims or demands are, or are not, wholly groundless, false or fraudulent. Witness S gnature Re v�®r egal Rep. Carleton Funeral Home, Inc. 15 Gibson Ave. , Hudson Falls, NY Address Address Signed on this date ��