Henderson, William TOWN OF QUEEN `Ll-'�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director / ` &7��
Name KJ1kA1 /JM a s e # �
Date of Crematicn 7-04� 9
Time Cremation Started L 14 d /M I
Time Cremation Completed '910 4!/vi \
Type of Container � /►��7u/7/�_� �Jr /� G iC / �/� 09
Remarks :
/l-1a Z46-- 1 i n17 >
TOWN OF QUEENSBURYO
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 subjece to its Rules and Regulations to
cremate the remains of:
William Henderson Male
(Name) (Sex)
Bldg. 170, Apt. 1, Robert Gardens North, Queensbury, N.Y. 12804
(Street ) (City) (State) ( Zip Code )
w h o died on July 25, 1999 d a y of July 19 99
at Eden park Nursing Home, 170 Warren st. , Glens Falls, N.Y. 12801
(Place) (Address)
Name and address of nearest living relative or name of perszr
authorizing cremation :
Mrs Patricia Eaglestone, 822 Diamond Point Rd. , Diamond Point, N.Y. 12824
(Name ) (Address)
Relationship to the deceased Daughter
Name of Funeral Home Alexander Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased X)gQQQM
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 t'he 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 , ceferz
and save harmless Pine View Crematorium from any and all c ; a ,.ms
and demands for loss or damages which may be made against them
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wno : : l
groundless, false or fraudulent .
(Witness ) (Address )
re'A A)ar7;��-
(Signature of elative or Legal Rep. and Address)
Signed on this date : 25 July 1999