Taylor, Joan Toq+N OF QUEEN.5Bu-, �Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name Case # �2ry2
Date of Crematicn
Time Cremation Started
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Time Cremation Completed �tJ5- )91 'in
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Remarks :
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 145-4477 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 :
Joan V. Taylor Female
(Name) . __. (Sex)
Rt. 30 Box 531 Indian Lake New York 12842
(Street ) (City) (Statte) ( Zip Code )
who died on 7th day of July 19 99
at her home Rt. 30 Box 531 Indian Lake, New York 12842
(Place ) (Address )
Name and address of nearest living relative or name of perscn
authorizing cremation :
Mr. Temple G. Taylor Rt. 30 Box 531 Indian Lake New York 12842
(Name) (Address)
Relationship to the deceased husband
Name of Funeral Home Alexander funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased XXXXXXXX
has no pacemaker in jb3000W her body. (Circle One)
I certify that I have the full power and authorization to arrange
for the cremation of t'he 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 , defer
and save harmless Pine View Crematorium from any and all cla - mi
and demands for loss or damages which may be made against them
reason of or connected with the cremation of said remains as
d cte whether such claims or demands are or are not wnoi : l
groundle s false or fraudulent.
Witness ) (Address )
(Signature of Relative or Legal R p. d Address)
Signed on this date : 7/7/99