Gilmour, Christopher T07+N OF QUEEN,5BUSy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, -NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name�' �� ��� % Case #
Date of Cremation ✓` 7 " ao,-:!p
Time Cremation Started 14::� / f«l`✓1 f
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Time Cremation Comole-ed l� �� P/M
Type of Containerf-l—/l?/9/C/—c) 7 zq:2 � [ `3I; C/7JiC�C1j�� --
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
&CREMATORIUM 350
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:
Christopher Gilmour Male
(Name) (Sex)
12 Prospect Drive Queensbury,NY 12804
(Street) (City) (State) (Zip Code)
who died on 13th day of July 2001
at 12 Prospect Street
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Regina McKenna Newell 2591/2 Main St., Hudson Falls,NY 12839
(Name) (Address)
Relationship to the deceased Sister
Name of Funeral Home Carleton Funeral Home,Inc. a
IMPORTANT:
I represent that to the best of my knowledge, the deceased has'" :r''. „has no
pacemaker in his or her body. (Circle Ones'' '
I certify that I have the full power and authorization to arrang$,-or fW- 'ptiorr
of the remains and to direct the disposition of the cremated remains, that and
personal possessions have either been removed or may be destroyed;; an.� agree
to protect, defend and save harmless Pine View Crematorium from ariy 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,fraud'lerrt
68 Main Street P.O.Box 67, Hudson Falls,NY U839
(Witness) (Address)
(Signature of Relative or Legal Rep. and Address)
Signed on this date: ) a C) `�