Ansell, Erold TOWN OF QUEEVBUP,.Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director alL06X- qya- z2&? Z
Name A / 66 11 od&7jiS L-k Case 3i -
Date of Crematicn Z ` /C�- / D
U
r�
Time Cremation Started /, "' !M
t
Time Cremation Completedf�
Type of Container j /7�/IV/ //16Z
Remarks:
A1111,14 1901 AIR o/v 1d% a,A41
f
/1 �I `/�,/T M ,
I� 1j /02&�/� /�.x/1
a an oil"04 4yaVM YYVV 1 U of in L b4.iJ LnL�IN Fwl" MI--/MY LA.,VW V.JU V •iJ a b . 1
".. IU/ab/% 22:43 Pg: i
FROM ALD, W1M FU4GRAL HWS PHONE NO. 5186232065 Jun. 10 IM W#49 M Pl
TOWN OF 0(JEENSSURY
PiNB VY�1� CEMitTi$RY
CREMATORIUM
avoker R4.d} . ;Queensbury, New York 12804
Prone (513) Cr*matoriva( 743-4477 or if no answer
C.9metory445-4476
AOTMQRI2AT.ION TO CREMATE
the. underti,gned obouesto and avthorixes Pine View• Crealattor&V*, in
abcordAhae with End tub j*ce to its Rules #nd Regulations to
ereaatf the romaln's of
Erold Ante11 M41e
Wozze oup Ao5tpAUr-i
t$trret ► (city) (State) (zip Cod0
who d i sd on 8 th • day .of June 19.
at Glens Fell$ H0bPitel,. Gl9hs Fells, NY 12801.
(pi ace) (AC dr9 ss)
Name Mnd• *ddrvv% of noarest living relative or nave of ppr5on
-authorizing ari0ation:
• Evs].yn.Ansa11 "
(Nam P) CAddro s s•)
Ike l at i onsh i p t a the deceased Mother
Namt bf Funeral 'Have Alaxondor4eker .Funere:. Home, Warrensburg, NY �
IMIpORTANT.a
I represent that 8o the besb of My knowledge, the deceased fKXXXYM
half no pacomakvr . in hi,s or.. her• body. . (Circle tine)
I certify that r have, !the full power anp outhorit4t ion to arrange
for the cremation, of the ro0ains and to direct the disposition of
,the ar9vot !d romaine,' that any pe'rsoneal ' possessions have either
been ' re.eovvd or .may be 'destroyed,' and agree , tie protect, defend
in save harmTfs' s pine, View Crepatorivo from any and all claims
ikna demands fo) % loos or' da►ma►ges which may be Mode against them by
raascsn qf . or connocteb with the Cremation of said remains et
.d,irectoii", .whether such c.lalms or 0.emengs. are or ary not wholly
' QI"puntll.e'tip� .1�dlitt or' fraudulent.
Y . ' �ifuc.a„r��a,�i ' oC•,/mil�4r►�ra c'r vup..mr �r+4'��a', r t�si
(Address) i
Lim SL� aw Its-re"
(Sign Relative or Legal Rep, and Address)
8! nod on 'th i s dat e e June 1Q, 1998
ti
i
err rant nu fit / o11'i-l"Al Sl101I I'll 15iN"'i HF'IY pd-1p4 11lNfillFi "711C. VU' 1!4
v
Ittl l l l 1',If ►11 If 1 11 1111 7 1 kill 11-1 1,11 ll`I`lW1,11 MIYII.1 I' I i 11A It
ACN 068 508 672
Trading As,
SMALL BUSINESS 11ELP SNUP
110 Box 218W, Weatcourt Qld 4870, Australia
(9 Elgata Close, Woree Qld 4868, Australia)
111111: 07 4033 5200 Fax: 07 4033 5570
8-mail: I~blis u:iblls.com
June 12, 1998
Mr John Alexander
Alexander Baker Funeral Home
114 Main Street
WARRENBURG NY 12885, USA
Fax: 0016.1.618.6 23 2066
Dear John
Ro: Eli-old Rimost ANSFI.I,deceaked
ltcfcrring 101110 arrant cmenty required for my partner and friend, Lrold. PJc,�se note that.I depart C'airnc at
film this morning enroule to Warrenbui-g to oversee: all melters Pertaining; to the suitable rand proper llllenliun
Ili-old face► in ills final ,journey. I will be in the c:orrlpany or.,, Miss Shobek Dillon, a luny, lime friend of
Lrold. Miss Dillon is a rogiswred nursing; Sister.
Following are the required fortes that you require in order to undertake tho cremation along with Town of
Queensbury Pino Viuw C onxetery & Crematorium "Authorization to Cremate" form. Please note Mar it i, a
physical impossibility to have L;rold's mother sign this form. I have done so under privilege of Will Power cat'
Atlorney and the authority g;ivcn by his mother, This latter aspect can be, confirmed via lbe Australitnl
Consulate general in New York (Rene Relrthordt - phone 212.151 6530).
The procedures we would like to sec Put in place: t+re.
llressllig: pownal clothing;will be collected from the cffecls held by Jnves0g;ator Mike Iluskic and Brolcltl
will be dressed by Miss Dillon providing;of course that this is accx.plablo to your company, Viewing: t+
privllte personal viewing of till:.body is required by Miss Dillon only. 11', and only If required I will
accompany her but in reality it is not my wish.
Cremation Is to foil", with approprintc delivery of the ashes to me to enable them to be preseni 91 a claws
(Gam) service scheduled Ito be hold at Prospect Mountain Summit, Lake George, Sunday Anic 141.11.
I will require lhu nocessary Crernafion C`.crlificatc and Formal Duath Certificate 10 be handed la r11e r►hmg; w ilh
the asiics. Wlint 1 have, not rcccivW for completion is any formnt of documentation which authorires you to
take delivery of the body from the hospital. PLEASE as a matter cif urgency fax Inc any relevant form c14 I
have to depart this office for file airport in sonic 2 hours t.inw.
' 11a 1k you for your efforts and time in assisting me with this difficult and yet vory spoc:ial task,
'1 rely;