Kappler, Erna T07+N OF QUEEVBU.'ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSHURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director � /�/] /✓ /\
Name jo/ /9arL.,EZ- - Case # q az-
Date of Cremation
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Time Cremation Started a , �JDl
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Time Cremation Compl et ed7/ t� t
Type of Container . 6 0-90 /RAD
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:
Erna Kappler Female
(Name) (Sex)
3037 State Rt. 8 North Creek. New York 12853
(Street ) (City) (State) ( Zip Code )
who died on 21st day of October 1998
at Adirondack Tri County Nursing Home North Creek, New York 12853
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
Erika Witt 3037 State Rt. 8 North Creek, New York 12853
(Name ) (Address)
Relationship to the deceased Niece
Name of Funeral Home Alexander Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased rXXXXXXX
has no pacemaker in NXX d(tX 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 , defena
and save harmless Pine View Crematorium from any and all claims
and demands for loss or damages which may be made against there by
r
of or connected with the cremation of said remains as
ect d, whether such claims or demands are or are not wholly
undl s, false or fraudulent .
(Witness ) (Address )
(Signatcvre of Relati a or Legal Rep. and Address)
Signed on this date :�0 �,'�