Underwood, Ralph SOWN OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director G�/Q�, �/�!
Name 9 ,k-e f Case #
Date of Cremation // ' 4 — acm
Time Cremation Started AM )
Time Cremation Completed /c2— ,, l<) P !M
Type of Container C/9&Zj2AqjJ
Remarks :
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TOWN OF QUEENSBURY i
PINE VIEW CEMETERY l
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:
Ralph Calvin Underwood male
(Name) (Sex)
r
37 Martindale Ave. Hudson Falls NY 12839
(Street) (City) (State) (Zip Code)
who died on the 13th day of November 2000
at Glens Falls Hospital , Glens Falls , NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
3
Doris Underwood, 37 Martindale Ave, Hudson Falls , NY 12839
(Name) (Address)
Relationship to the deceased wife
f
Name of Funeral Home Gar->=eten Funeral Hwe Ine,
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or no)
---
pacemaker in his or her body. (Circe 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.
OCI�3' 7 �v �37 Martindale Ave, Hudson Falls NY 12839
/( a'�'Wi (Address)
l 68 Main St , Hudson Falls, -NY 12839
(Signature of Relative or Legal Rep. and Address)
Signed on this date: 11/13/on