Beecher, Carl TO OF QUEEN5B U99 y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, :v'EW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Ir,�,/�,
Name G/gj��, ,a �G`��, Case #
T•
Date of Cremation
Time Cremation Started 6 t#6 /1/-m i
Time Cremation Completed �Fo2� l7l�'
Type cf Container o -0 A; T-C1'95•���' �T/�,46- T��'
Remarks : ��
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�'�`C�3 i9�M �
FROM M.B.KILMER FUNERAL HOME FAX NO. May. 17 2001 04:55PM P1
TOWN OF VUEENSRLIRY
NINE VIEW C,FMETERY
CREMATORIUM
Quaker Road Queenspury, New York 12804
Phone(618)Crematorium 745-4477(if no answer)
Cemetery 746-4476
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
Carl N. Beecher Male
(NAME) (SEX)
106 Old West Road, Gansevoort, NY 12831
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 16th day of May 20 01
at 106 Old West Road, Gansevoort, NY 12831
(PLACE) (ADDRESS)
Name nd address of near t living relative or name of person authorizing cremation:
Relationship to deceased__'hn
-
Name of Funeral Home M.B. Kilmer Funeral Home, 136 Main St., So.Glens Falls. NY
IMPORTANT
I represent that to the best of my knowledge, the deceased_hil r ha acemaker 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 jamains,that any personal possessions have sitheF 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 or are not wholly groundless. false or fraudulent.
(WITNESS) (ADDRESS)
(SIGNATURE OF RELATIVE OR LEGAL REP.AND ADDRESS)
Signed on this date:
R
FROM : II.B.K.I LMER FUNERAL HOME FAX NO. May. 17 2001 07:55PM PI
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