Townsend, Edward II T074N OF QUEEN B`Ll9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director C,19940e-/ e A
Name is Irf�J�!� �7 ��C as e #
Date of Cremation
Time Cremation Started 7,4 zjy/Y7 f
/ n^
Time Cremation Completed I p�/Y11 - - T
Type of Container oz/ wy /T/I P 1-5 /.
Remarks :
,42 114 A4
19 /n- f
I
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:
Edward Francis Townsend Male
(Name) (Sex)
23 Lincoln Street Hudson Falls, Hey York 12A3Q
(Street) (City) (State) (Zip Code)
who died on 9th day of July 99
at Glens Falls Hospital Inn Park Strpat Glens Falls, NY 17Ani
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Kra. Elinor Townsend 23 Lincoln street
(Name) (Address)
Relationship to the deceased rife
Name of Funeral Home .Q TIC- -
GZ�S 1CjlTt�
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or 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, defend and save harmless Pine View Crematorium from any and A
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,
wh ther such claims or demands are not wholly groundless, false or fraudulent.
Carleton Funeral Home, Inc.
(Witness) -� (Address)
Hudson Falls , NY
(Signature of Relative or Legal Rep. and Address)
Signed on this date: -71