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Carma, Abraham
rl'oWN OF QUEEN .s,5BU9KY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral DirectorcAa,&'7c/� NameC' n� Case # Date of Cremation Time Cremation Started b f SE7 r/A I r Time Cremation Completed ! �s r� Type of Container S© Remarks : `lS <� X i JYl I < IS rAl I I I I I II TOWN OF O,UEENSBURY 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: Abraham G. Carma Male (Name) (Sex) Wesley Nursing Home Saratoga Springs,NY 12866 (Street) (City) (State) (Zip Code) who died on 6th day of January 2001 at Wesley Health Care Facility Lawrence St. Saratoga Springs,NY 12866 (Place) (Address) i Name and address of nearest living relative or name of person authorizing cremations: Linda Pepe 11 Wynnefield Dr., South Glens Falls,NY 12803 (Name) (Address) Relationship to the deceased Niece Name of Funeral Home Carleton Funeral Home,Inc. IMPORTANT: j I represent that to the best of my knowled e, the deceased has or . ,:oqq�pno pacemaker in his or her body. (Circle One I certify that I have the full power and authorization to arrange for the:.cremat(on e. of the remains and to direct the disposition of the cremated remains, that4rny.) personal possessions have either been removed or may be destroyed, and agree to protect, defend and save harmless Pine View Crematorium from any and.,alt 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. 68 Main Street P.O.Box 67, Hudson Falls,NY 12839 ( itness) (Address) 'z� Y��' 11 Wynnefield Dr. , S. Glens Falls, NY 1280J (Signature of Rel tive or Legal Rep. and Address) Signed on this date: Jan 6, 2001 i