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McNeill, Arthur TOWN OF QUEEN,5BU9� PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director Name AR7- U1f Case # Date of Cremation �/ "� aoo'-5 Time Cremation Started Z� L� elm Time Cremation Completed PlM � Type of Container Gh�,qegq/'qfi-p Remarks : ��� sx /q TOWN OF QUEENSBURY PINE VIEW CEMETERY & P�� 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: Arthur Edward McNeill Male (Name) (Sex) 5 Bateman Drive, Warrensburg, New York 12885 (Street) (City) (State) (Zip Code) who died on the 7th day of November 2000 at The Glens Falls Hospital, Glens Falls, New York 12801 (Place) (Address) Name and address of nearest living relative or name of person authorizing cremation: Mrs. Agnes L. McNeill (Name) (Address ) Relationship to the deceased Wife Name of Funeral Home Alexander Funeral Home Inca . IMPORTANT: I represent that to the best of my knowledge, the deceased 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-arid 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 groundless, false or fraudulent. 014MV, � Daniel J. Gravel 3809 Main St. , Warrensburg NY 12885 (Wi ness ) (Address) (QekVLJ1C, 5 Bateman Dr., Warrensburg, New York 12885 ( gnature of ative or Legal Rep. and Address ) Signed on this date: 04/13/95