Brown, Eunice TOWN OF QUEENSBURY -77- -7
PINE VIEW CEMETERY
a
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
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:
Eunice Caroline Brown Female
(Name) (Sex)
Indian River Nursing Home Granville, NY 12832
(Street ) (City) (State) (Zip Code)
who died on 24th d a y of October 19 96
at Indian River Nursing Home Route 40 Granville, NY 12832
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Mrs. Dorothy E. Purdy RD 2, Box 2091
(Name) (Address)
Relationship to the deceased Sister
Name of Funeral Home Carleton Funeral Home Inc.
IMPORTANT:
esent that to the best of my knowledge, the deceased has or
has Dnopacemaker 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
an demands for loss or damages which may be made against them by
rea on of or connected with the cremation of said remains as
di cted, whether such claims or demands are or are not wholly
g o ndle s, false r fraudulent.
68 Main St. , Hudson Falls, NY 12839
(Witness) (Address)
RD 2, Box 2091, Fort Ann, NY 12827
(Signs ure of/
f Relative or Legal Rep. and Address)
Si gngd on this date :_ 10/24/96