Colvin, Frank 2a0WN OF QUEEVBU9 Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director (f/7�► T/1�
Name l lml` tn6l-111 Y Case # �
Date of Cre mat i cn C 0
Time Cremation Started
Time Cremation Completed
Type of Container i9�c,CaT �r9s�r�ra��iG .�t"a'/c7%
Remarks :
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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:
Frank J. Colvin Male
(Name) (Sex)
21 A Wall St . , Hudson Falls , NY 12839
(Street) (City) (State) (Zip Code)
who died on 21st day of October 1998
at Veteranls Aclmin Merl Ctr H= 113 Holland Ave. Albany', NY 12208
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
I
Mrs Cherilynn Colvin, 6 Martindale Terrace, Hudson Falls, NY
(Name) (Address)
Relationship to the deceased wife
Name of Funeral Home Carleton Funeral Home Tnc.
IMPORTANT:
represent that to the best of my knowledge, the deceased has or has no j
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 not wholly groundless, false or fraudulent.
I
68 Main St . , Hudson Falls , NY
(Witness) (Address)
gnature of Relative or Legal Rep. and Address) j
Signed on this date: October 22 , 1998