O'Hagan, Margaret 707+N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director djfCkJ,E-/\
Name /1/!99111fk- 6 ' &/J,&Case #
Date of Cremation
Time Cremation Started
Time Cremation Completed?� lm
Type of Container
Remarks :
iM
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l
TOW OF OI BURY
PINE VIEW CEMETERY
8
CREIMATORIUNI
Quaker Road, guawnsbury, New York 1z8e
Phone ' (518) CreadLtoriu* 745-4477 or if tic aPSwer
Cemetery 745-4476 I
AUT"CR I ZAT I ON T13 CR04RT•E
T�10 µndersigned requests and authorizes Pine View Grenatorium, in
accgrdahco Witt-, and subject to its Rules and R� gulations to
cremate the retains of:
Margaret Ann O'Ragdn 'Female
(Nave) (Sox)
5abael Rd Indian Lave. NY � 12842
(Street) . (City) (State) (Zio Code)
who died On 24 day of Sept. 19 97
at Glens Falls Hospital, Giets F-11S. W-
(Place) tAddress)
Name and address of ne.arest living relative or name of person
authorizing erovat i on s
aorr8lne B. Pruden sabael led.. Tndian Lake, NY 12842
(Name) (Addrtgsi
Relationship to the deceased mother
NamO of Funeral •Home Braver Funeral ROme,Inc
I
IMIPORTfW7
I represent that to the best of my knowledge, the deceased has or-
es no pacemaker in his or her body. (Circle One)
I etrtify that I have the N11 power and authorization to arranges
for the Crttge,:ion .ef' the remains and to direct the dispoSition of
the cremated remains, that any personal possessions have either
been removed or nay be destroyed, and agree to protect, defend
and save harmless, Pine View Crematorium from any and ' all claims
and demands for lose or damages which may be made age►inst them by
reason of Or connected with the eremation of said remains as
directed, whether suds claims or demands are or are not wholly
gr ndless, false e.r fraudulen't
CN' "ess)• (Address)
( ignature of Relative or Logal. (tep. and Address)
Signed art this date: 9 , 97