Bennett, John �o OF QUEEN
,5B U9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 6 75/(
Name 111 i ,fj /Y/ Z Case # Zbl
Date of Cremation
Time Cremation Started 41,4 - f 9(Y7
Time Cremation Completed ���p2 dfm f
Type of Container
Remarks :
IAJ
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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:
John Pashley Bennett Male
(Name) (Sex)
69 John Street Hudson Falls,NY 12839 12839
(Street) (City) (State) (Zip Code)
who died on 6th day of February 00
at 69 John Street rfi,a--mn Fal l G NY 12839
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Ruth Bennett 69 John StreetHudson Falls,NY 12839
(Name) (Address)
Relationship to the deceased Wife
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or 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, 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 re son of or connected with the cremation of said remains as directed,
whet er such claims or demands are not wholly groundless, false or fraudulent.
68 Main St Hudson
(Witness (Address)
1t6::9:John St. , Hudson Falls, NY 12839
(Sign ture of Relative or Legal Rep. and Address) .
Signed on this date: 2/8/00