Knoll, Francis T07+N OF QUEEN 21�WY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director � /�/�/r �/1
Name �� /I��%/t-5, Case
Date of Cremat i cn
Time Cremation Started/0212-�—Ipl`to
Time Cremation Completed ��do lyi l
Type of Container
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 :
Francis Knoll Male
(Name ) (Sex)
211 Bear Pond Rd. , Athol, N.Y. 12810
(Street ) (City) (State) ( Zip Code )
who died on 7 th• day of Dec. 1998
at His residenbear Pond Rd. , Athol, N.Y. 12810
(Place ) (Address)
Name and address of nearest living relative or name of perscn
authorizing cremation :
Anne M. Knoll (Wife) 211 Bear Pond Rd. , Athol, N.Y. 12810
(Name) (Address)
Relationship to the deceased Wife
Nave of Funeral Home Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased .
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 , defenc j
and save harmless Pine View Crematorium from any and all claims
and demands for loss or damages which may be made against there bD
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholiy
grounsOessA,07false or fraudulent . j
211 Bear Pond Rd. , Athol. N.Y. 12810
((WW'itn ss ) (Address )
Bear Pond Rd. , Athol, N.Y. 12810
(Signature of elative or Legal Rep. and Address)
Signed on this date : dec. 7, 1998