Harrington, Thomas TO`l1iN OF QUEEM475BU-WY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name 1 /,/V I f7{� ll� 11 F��'k%/ Case # -�
Date of Cremation ~ >>
Time Cremation Started �' Aq
Time Cremation Completed
Type of Container I/ ARL
Remarks :
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:
Thomas H. Harrington Male
(Name) (Sex)
I57Prosser Circle, Warrensburg, NY .12885
(Street ) (City) (State) ( Zip Code )
who died on 19th day of Feb. 1999
at Glens Falls Hospital
(Place) (Address )
Name and address of nearest living relative or name of perscn
authorizing cremation :
Lynri.Granger0 1jZ) �� N� Hudson Falls, NY / 7- F3q
(Name) (Address)
Relationship to the deceased Daughter
Nave of Funeral Home Alexander Funeral Home, 3809 Main St. ,Warrensburg, NY
IMPORTANT:
I represent that to the best of my knowledge, the deceased MX.xaXXX
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 , defenc
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
di r whether such claims or demands are or are not wnol : .
roundles , false or fraudulent .
Warrensburg, NY
"` itness > (Address )
Same as above
ignature oT Relative or Legal Rep. and Address)
Signed on this date : 2-19-99