Radliff, Danielle TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
21 Quaker Road, Queenshury, NY. 12804.5902
(518) 745.4476 (518) 745-4477
http://wNvw.queensbury.net
Funeral Director:
Name of Deceased:
Case Number:
Date of Cremation:
Retort:
Time Cremation Started:
Time Cremation Completed:
Type of Container: (r A'*-L( cp 5Kt�L1 /A 1j aj S S A✓'��
Remarks:
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" Home of Natural Beauty ... A Good Place to Live "
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 128N
Cemetery Office: (518)745-4476,Crematorium: (518)745 ;
Authorization to Cremate
The undersigned requests and autitoriaes Pine View Cremes ftim,in accordance with and subject to its RuIes and Re=,
cremate the remains oF. lons to
Danielle Ann Radliff F
(Nam) (SOX)
59 Mechanic Street Fort Edward NY 12828-
(Street) (CRY) (State) (Zip Cade)
who died on 18th day Of Jan. 2q06
Glens Falls Hospital Glens Falls NY
at
(Piece) (Address)
Name and address of nearest WAM relative or name of person autiro b*V cremation:
Kimberly Radliff 59 Mechanic Street
(Name) (Address)
Mother
Refafimrsfye to fhe deceased
Name of Funerat Home Carleton Funeral Home, Inc. TR
IMPORTANT:
I represent that to the best of my bowledge.the deceased(has) (has no maker,defrb koor or any other ba lWy operated
device in ttis or her body. (Cirde One)
I certify brat I have rutl power and autirorization to arrange for the aema Lion of the remains and to d ect the disposition of the
cremated remains,that any personai possess on have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crematorium ftm any and ag etalrns and demands for loss at damages vrhich may be made agairwt them
by tied with cremation of said remains as direcmd,whether such cairns or demands are or are net w"
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(Address)
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(Sign and Address of R Legs Represatltative}
Signed on this dale:
Oisposilion of Cremated Remains
I hereby dWW Pine View Ctarnstarhrm to dispose of fhe cremated remains as fbNOM:
Man to
Othw arrangements-Please spec fy:if p*enzoon of cremated remains Is requested,efreelc here XX
Revision:January 1,2006