Switser, Clyde Sr. ' rO T0N` OF QUEEN,5BURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 6:191?Z,6:-15/\1
Name �y�� S4/.,1�5�X :5 Case #
Date of Cremation
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Time Cremation Started 07— P.,/V)-
Time Cremation Completed p2-�t c► l
Type of Container cc ccIV Z- J1-?P,-
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TOWN OF QUEENSBURY lyz6
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:
Clyde L. Switser Male
(Name) (Sex)
150 Dike Road Fort Edward, New York 12828
(Street) (City) (State) (Zip Code)
who died on eleventh day of August, 20000
at Albany Medical Center Hospital , Albany, New York
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Mrs. Linda Switser, 150 Dike Road, Fort Edward, New York 12828
(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 reason of or connected with the cremation of said remains as directed,
whether such claims or demands are not wholly groundless, false or fraudulent.
0'.J. dj� 68 Main Street, Hudson Falls , NY 12839
14.Witness) (Address)
e , � 150 Dike Road, Fort Edward, NY 12828
(Signatur of Relative or Legal Rep. and Address)
Signed on this date: 8/12/2000