Patten, William TOq+N OF QUEEN.5Bu—wY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /�,7 /1�/vn.'
Name �LJ�f LL1 OM /Case # �d
Date of Cremation
Time Cremation Started �1 �/✓ �/Y)
Time Cremation Completed f 15:9 /71(41
Type of Container
Remarks:
11 i/ g'�35�1�'/V1l
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:
William A. Patten Male
(Name) 1 Myrtle Ave. (Sex)
McClellan Systems Skilled Facility Cambridge, NY 12816
(Street) (City) (State) (Zip Code)
who died on 24th day of October 1999
at McClellan Systems Skilled Facility Cambridge, NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation: 780 County Route 77
Brent Patten Bald Mtn. Rd. Greenwich, NY 12834
(Name) (Address )
Relationship to the deceased Son
Name of Funeral Home Flynn Bros. , Inc. - Greenwich, NY
IMPORTANT:
I resent that to the best of my knowledge, the deceased has or
as to 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, defend and
save harmless Pine View Crematorium from any and all claims and
demands for loss or damages which may be made against them by
reason of or connected with the cremation of said remains as
directed, whether such claims or demands are or are not wholly
undless alse�or �fru lent.
80 Main Street Greenwich, NY 12834
( i ne ) (Address
780 ounty Route 77
Bald Mtn Rd. Greenwich, NY 12834
(Sign ture of Re ative or Legal Rep. and Address)
Signed on this date: Oct. 24, 1999
# Funeral home will pick up cremains