Thomson, Grace TOWN OF QUEEVBU9�
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Ci �2, -'� N-
Name C'y-O� c, '�"1�6�'l .�6 Case# 6? V
Date Of Cremation l nJ t Z O C C_0
Time Cremation Started
Time Cremation Completed
Type of Container c'V:4n oo&Z� 4 �a 41%, 4- "L c) 3 Rt,
Remarks
r
L-
Town of Queensbiny
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Office:(518)7454476,Crematorium:(518)745-4477
Authorization to Cremate
The wWws geed rativasta and ecdrort w$Pane ViSw Crernatorkrm,in ac owdenoe with and subject to its Rules and ReWbrtlons to
cmffwe the rems a of
Grace Thomson F
25 Hillview Hudson Falls NY 12839-
( )01/26/2006 ( (State) (ap Code)
who died on day of 20_
Residence Hudson Falls NY
at
(Place) )
Now and addMM of newast oft tekWm or nom of pemson augxwukV aernatiorr:
Beth Woods 25 Hillview Drive
(Name) (Address)
Reworshp to#m deceased Daughter
Nam off=unwWHome Carleton Funeral Home, Inc. T_
MPORTANT:
I reprem*rust b fie best of my kivAdedge,the deceeaed(has)or�pamnaker,defib gow or any other battery OperoWd
device in his or her body. (Cide One)
t oettify that t have Arli powrer and aLOXXft"M to arrange Im the oremadm or the tetnekts and to direct the ftmeitiati of the
crerrtted remains,*et any personei posees8kM have afar been removed or may be deWayed,and apnea to prokct,deim+d and
am ha mim Pkv View Gremetiortum ltom any and A dteittie and demwide for ions or deiffie s vkdch MW be made agwnst tfiem
by meeort of or o xwwctad wtdt the awne*m of seW rM,mtis ns directed,%fw#w such Clef=or demerids are or are not w h*
�,A*e�
(vineries) (Addiem)
( aM Address of Relative or Legal Represetitadve)
Signed on this date: 1 127 1G(-.
DKwskion of Cro'nated Remains
I hereby direct Pine View Cierra Wnurn to despow of tree aerneted mn ias as Mows:
Mad to
othererrengWMMs-Pieria specify Dick �+ - t' A.rtclsf-
if pulvertxetion of cremated rgtaem is requested,diw*here XX
Revision:Jamixy 1,2W6