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Harrigan, Arthur rrO l+N OF QUEEVBU9U PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director h-��XkV Name Case # Date of Cremation Time Cremation Started t ^^ Time Cremation Completed® , /© DIY J Type of Container /� '�Z fj 90.2 CA5-E- c)/:::� 7Tiy�" Remarks : .L�,�` ��a9i9�M FROM LAHDESIGN PHOrIE NO. : 9147384007 Jan. 07 2001 12:2'?PM P1 01la7/2E�01 11:50 51853�7177 PAGE 01 TOWN OF QUEEN8BURY PINE WW CEMETI RY 8 CREMATORIUM Quaker Road,QUeenebury, New York 12804 Phone(618)Crwriatorlurn 745- 477(If no answer) Came"74"78 AUTHORIZATION TO CREMATE The undersigned requests and aulhoraes Pine View Crsmatoriurn, to acordance with and subject to Its Rules and Regulations tO Cremate the rett IM:Of. (NAME) fSEX) U-3 7 , c� (STREET) (CITY) ( ) P t") who died an day of A A- 21;IiL at (PLACE) ( 88) Name and address of nearest living re4tive or name of person authoozing cremation: �u AAJ ,6 I44 "Ad1� G Relationship to deceased A/} Name of Funeral Horror rL' FL)�j e 04 /x elv IMPORTANT I represent that to the best of rry knowledge,the dw*osed hK 06�;" m"r In his or her body (CIRCLE ONE) I oertily that l have the full power and authorization to arrange for the cremation of the remains and to direct the disposltlon of the orematad remains that any personal possessions have siftirti0en removed or may be destroyed,and agree h protacw defend and slave narmoao Plr)a Vlwu Crematorium tom any and all claims and demands for loss or dwreaw which may&iOi•de' c agaslst Ibsen by reason of or oonnacted with the crenrattdn Of Wid ren%Nns os dW0e%d;Wfl~ such e=Nar knot wholly grou Ise or lkaudulen7 C Tc gg) I (AD ES !w C (519NATURE OF RFELATTVTORLicG&REP,AND AD ) Signed on this date: J L i