Cudney, Fay uYJi:s.aL:G ..........
TOT�N OF QUEEN,5BWKY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director d —�X '0"-
Name Case #__6-V4;7,
Date of Crematicn
Time Cremation Started / =1
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Time Cremation Completed l /
Type of Container
Remarks :
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TOWN OF OUEENSBURY
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:
Fay Cudney Female
(Name) (Sex)
46 Alden Avenue Warrensburg New York 12885
(Street ) (City) (State) ( Zip Code )
who died on 8th day of December 1998
at Glens Falls Hospital Glens Falls, New York 12801
(Place) (Address)
Name and address of nearest living relative or name of perscn
authorizing cremation :
Candace Kelly 48 Hidden Hills Drive Queensbury, New York 12804
(Name ) (Address)
Relationship to the deceased daughter
Nave of Funeral Home—Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased XXXXXX:X'X
has no pacemaker in )QXXXXX((�( 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
an demands for loss or damages which may be made against them oy
easo of or connected with the cremation of said remains as
direc e , whether such claims or demands are or are not wholly
grow ess, false or fraudulent .
( itness ) (Address )
(Signature of Relative or Leg ep. and Address)
Signed on this date : December 8, 1998