Monroe, Karl 1 i
TO q4N OF QUEENs5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 4lY
Name &Aa Case #
Date of Cremation
Time Cremation Started Zcz/fz
Time Cremation Completed C�"x:�o
T y p e o f C o n t a i n e r
Remarks :
I
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:
Karl I. Monroe Male
(Name) . (Sex)
3485 State Route 9 New York 12845
(Street ) (City) (Statte) ( Zip Code )
w h o died on the 24th d a y of July 1999
at 3485 State Route 9 (Residende)
(Place) (Address)
Name and address of nearest living relative or name of persc "n
authorizing cremation :
Ji.m,.Monroe- 2511 Pauline Ave. , Schenectady, NY 12306
(Name) (Address)
Relationship to the deceased Son
Nave of Funeral Home Alexander Funeral Home
IMPORTANT:
I e resent that to the best of ray knowledge, the deceased has or
as n 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 , Oefenc
and save harmless Pine View Crematorium from any and all claims
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 wnol : 1
groundless, false or fraudulent .
John S. Alexander 3809 Main St. Warrensburg, NY 12885
(Witness) (Address)
Signature of Relative or Legal Rep. and Address)
Signed on this date : July 26, 1999