Whiting, Stewart L. rtnq4N OF QUEEVBU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
` � Y JIJ/7-1�Funeral Director c/91(tF7TNames7;�J& � Case # ,
Date of Cremation Z— 1,-7 '-zede
Time Cremation Started ,Z/ /.5—.? /9"M f
Time Cremation Completed
Type of Container ��p�a/jr�j�' "Ily
Remarks : _�.—yL���
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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 requests and authorizes Pine View Crematorium, in accordance with
and subject to its Rules and Regulations to cremate the remains of:
Stewart Parshall Whiting Male
(Name) (Sex)
Fort Hudson Nursing Home, Fort Edgard, NY_
(Street) (City) (State) (Zip Code)`" �-":`"
who died on 15th day of January - 00
at Fort Hudson Nursing Home Upper Broadway Fort Edward,NY 12828 .
r--
(Place) (Address) f._ .._
i
Name and address of nearest living relative or name of person authoriz'thg cren ions:
Mrs.Nancy Collins 4 Linden Dr.Hudson Falls,NY 1039 ,
(Name) (Address)
Relationship to the deceased Daughter „ :, •; �.,� ,
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased . has
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, thatpny ear.
personal possessions have either been removed or may be destroyed, and agrees;;
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 not wholly groundless, false or fraudulent.
Jy� ✓1 - Carleton Funeral Home, Inc.
Witness (Address)
Hudson Falls, NY 12839
(Sign ture of Relative or Legal Rep. and Address)
Signed on this date: �'�