Sweetser, Edythe UEEN
r 1,%wN OF Q t5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director '/ 1'o'
Name E J k Cf, SIC Case # -5.s d
Date of Cremation 1 ' 2 -3 - q
Time Cremation Started 1 10 �a ` V `
Time Cremation Completed O
Type of Container ��A\�{� T3G NR,� CO N -- C' (A} s °v r
Remarks :
I
s 5^a
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:
Edythe E. Sweetser Female
(Name) (Sex)
36 Sunset Dr. , Adirondack, NY 12808
(Street) (City) (State) (Zip Code)
who died on the 20 day of Novembpr 199_
at Riverwood Nursing Home - 21 Atateka Drive, Chestertown, New York 12817
(Place) (Address)
Name and address of nearest living relative or name of person
au4--11U�iz J ng cremation:
Donald P. Sweetser 36 Sunset Dr. , Adirondack, New York 12808
(Name) (Address )
Relationship to the deceased Son
Name of Funeral Home Alexander Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased )pwuM
has no pacemaker in I X= 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
ted, whether such claims or demands are or are not wholly
groun ess, false or fraudulent.
VArallc
(Witn (Address )
All
�,WIE �9I /�3JvG
( Si ur of Relative or Legal Rep. and Address )
Signed o is date: