Weller, Josephine TORN OF QUEENs5BU9Zy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY. NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name \� `l J /Ti/� Lt . h{,f � Case #
Date of Cremation
Time Cremation Started
Time Cremation Completed
Type of Container 1'?��f /1 / / /�'L`J��' 17j-71 1
Remarks:
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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 requ-asts and authorizes Pine View Crematorium,
accordance with and subject' to its Rules and Regulations to
cremate the remains of:
Josephine Weller Female
(Name) __. _-. (Sex)
Bowen Hill Rd. Warrensburg, NY 12885
(Street ) (City ) (State) ( Zip Code )
who died on 14th day of March 1 9 99
at Glens Falls Hospital
(Place) (Address)
Name and address of nearest living relative or nave of perscn
authorizing cremation :
Norman E. Weller, Bowen Hill Rd. , Warrensburg, NY
(Name) (Address)
Relationship to the deceased Husband
Name of Funeral Home Alexander FH, Warrensburg, NY
IMPORTANT:
I represent that to the best of my knowledge, the deceased Ng*xxax
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 eitner
been removed or may be destroyed, and agree to protect , defenc
and save harmless Pine View Crematorium from any and all clams
and demands for loss or damages which may be made against them L-•,
reason of or connected with the cremation of said remains as j
directed, whether such claims or demands are or are not wnol :
groundless) false or fraudulent .
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witness) (Address )
Same as above
(Signature of Relative or Legal Rep. and Address)
Signed on this date : 3-15-99