Harrington, Gladys rrnrnN OF QUE
EN
5BUJ�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director C'hW,C)6�- 70z
Namer��j Y) R/�A162r �5AI Case # 3 9�
Date of Cremation � "�� e.2061
Time Cremation Started
Time Cremation Comoleted
Type of Container 0)c
Remarks :
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
'hone (518) Crematorium 745-4477 or if no answer 1
Cemetery 745-4476
AUTHORIZATION TO CREMATE
�Theusigned requests and authorizes Pine View Crematorium, in accordance with
and subject to its Rules and Regulations to cremate the remains of:
Gladys Harrington Female
(Name) (Sex)
237 Main St. Hudson Falls,NY 12839
(Street) (City) (State) (Zip Code)
who died on 16th day of July 2001
at Glens Falls Hospital 100 Park Street Glens Falls,NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Shawn M. Saville 1 North Oak St, Hudson Falls,NY 12839
(Name) (Address) ..
Relationship to the deceased Grandson .w
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has no
pacemaker 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 remains, that any
personal possessions have either been removed or may be destroyed, and agree t
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,
whet er such claims or demands are not wholly groundless, false or fraudulent.
68 Main Street P.O.Box 67, Hudson Falls,NY 12839
(Witne ) ddress)
(Signature of Relative or Legal Rep. and Address)
Signed on this date:
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