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Strosky, William TOq+N OF QUEEM4,5BURY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director ,-I AZ, Name � ��,( S '2"1-?<gs Case # 6�d0 Date of Cremation Time Cremation Started 7 Al 1 Time Cremation Completed I r j4o & M , Type of Containar4A9p0dA69Z2 157CJ95 k © Remarks : %�� � 'Al? ' TOWN OF QUEENSBURY 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: William Stroskv mal (Name) (Sex) 9 May St. , Glens Falls, NY 12801 (Street) (City) (State) (Zip Code') who died on 22nd day of July, 2001 at 9 may St. , Glens Falls, NY (Place) (Address) Name and address of nearest living relative or name of person authorizing- cremations: Barbara carnevale90 Blanchard Rd. , Gansevoort, NY 12831 (Name) (Address) j Relationship to the deceased daughter i> Name of Funeral Home Gar=eten Funeral L7,,,..,. Ine , IMPORTANT: I represent that to the best of my knowledge, the deceased - has no pacemaker in his or her body. (Circle One) ----' St. i certify that I have the full power and authorization to arrang._ of the remains and to direct the disposition of the cremated remains, L personal possessions have either been removed or may be destroyed, antt-a- . to protect, defend and save harmless Pine View Crematorium from .a'n,y ar�;aL �ii 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'ulent.' Carleton Funeral Home, Inc. r VI (Witness) (Address) V"� gansevoort, NY (Signature of Relative or Legal Rep. and Address) Signed on this date: 7/23/01