Fuller, Frances TOWN OF QUEEN,.,5BUPy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name /1 /�G/ems �U�f�,� Case # �5
Date of Cremation _ a—ze
Time Cremation Started �, fo �►' I
Time Cremation Completed
Type of Container /17,4:12PZY
Remarks :
�J ,,Q
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 ,
accordance with and subject to its Rules and Regulations to
cremate the remains of :
Frances M. Fuller Female
(Name) __. (Sex)
49 Oak St. Warrensburg, N.Y. 12885
(Street ) (City) (State) ( Zip Code )
who died on 16 Th. day of Aug. 1999
at Adirondack Tri County Health Care Facility, North Creek, N.Y.
(Place) (Address)
Name and address of nearest 'Living relative or name of per-SC7
authorizing cremation :
Mrs. Mary Nolander, 7997 Glenwood Dr , Romp, N.Y. 11440
(Name) (Address)
Relationship to the deceased Niece
Name of Funeral H o m e Alexander Funeral Home
IMPORTANT:
I represent that to the best of ray knowledge, the deceasedXznocAX
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 eitner-
been removed or may be destroyed, and agree to protect , defenc
and save harmless Pine View Crematorium from any and all
and demands for loss or damages which may be made against the. m C .
reason of or connected with the cremation of said remains as
d ted, ,, whether such claims or demands are or are not wno . :
groun e. , false or fra du ent .
(Witness ) (Address)
1 ,
X Mrs. Cairenn L. Young, A.T.C.H.C.F. , Ski Bowl Rd. , North Creek, .N.Y.
(Signature of Relative or Legal Rep. and Address)
Signed on this date : ,-'yZ—y'9