Golden, Peter 70 WN OF QUEENs5BUS.Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /�/�//�/r G� /�//� �x
Name �/C• ! i? ib ,-D'E71J Case #
Date of Cremat i cn
Time Cremation started _ 41,
t
Time Cremation Completed /A 'co it ry-1. `
Type of Container ef /79J/ig6 9,T> t wpt
Remarks :
AiA/ N
1
l� !Izz �3 /M
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GOLDEN HANDS PKG. & MVG_ 9147640996 + P. 02
FROM ALEXANDER FUNERAL HOMES PHONE NO. Jan. 06 1950 05 40F"M P2
TOM Or UUEENi:R•URY
plNE VIEW CEMKTERY
CREMATORIUM
Quaker Road, Q uieensbury, New York
Phone (316) Crematorium 745--4 477 or if rio answer
Cemetery 745-4476
AUTHORI ZATIC3N TO CREMATE
The undersigned requests and authorizes pine VLff- CrematOl-l", In
accordance with and subject to its Rules and Reguiations to
cremate the rumainp of•_
PeterD. GCkl, M kiale
(Name) (Sex)
51- TuClcer 24,. Sta Creek N X 128713
(Street) (City) (State) (rip Code) -
who died an
5Th d a y of f ---,-�'�h 19 9$
at Glens Ea1.1.S IjOS12ital, Pa St.r Glens Falls N.X. 12801
(Plane) (Address)
Nape and address of nearest living relative Or nape of person
authoriZinig cremation:
pIebor.A
Re*Ii Golden. 100 M t Woods Rd Pound 'j doe -
(Name) (Address)
Relationship to the deceasedDaughter
Nose of Funeral How# Adirondack CreMation ABsoCiates
INWRTANT s the
I r resent that to ate best of my knowCidcle One)deceased has o►-
has no pacemaker in his or her body.
I C*ertify that I have the full power and authorization to arrange
for the cremation of the remains and to direct
the
h disPositivAOf
the cremated r*ealns, that any p P
osswssigns have either
been rtaOved or may be destroyed, and Agree to protect, dvfend
land save harpies% Pine View Crematorium from any and all claims
and demands for loss or damages wh3Ch May be made against them by
reason of or cOnnectwd with the cremation of said remains Al
tli d, whether such claims or demands are ar are not wholly
ground) ts, or fraudulent.
11UZG
(Witness) (Address)
VU1.1 Jav-6—C*& ]An I&I-get WcOdA Rd.. P-und RidM, Rx Y. 10576
(Signature of Relative ar Legal Rep. and Address)
Signed on this dates Jan. Fir 1998