Goodrow, Joan 70 WN OF QUEEN,5BUJU
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Date of Crematicn
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
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:
Joan W. Goodrow emalP
(Name) (Sex)
17 Alexandria Ave. , Ticonderoga, New York 12883
(Street ) (City) (State) (Zip Code)
who died on
23rd day of July 1998
at Fletcher Allen Health Care Center of Burlington, Vermont
(Place) (Address)
Name and address of nearest living relative or name of person
a orizing cre ation:
A
Ticonderoga, New York 12883
(Name) (Address)
Re ionship to the deceased daughter
Name of Funeral Home Wilcox & Regan funeral home
IMPORTANT:
I represent that to the best of my nowledge, the deceased has or
has no pacemaker 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
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) (Address)
( i nat re o Relative or Legal Rep. and Address)
\+
Sinned on this date: