Meroski, Frank OF QUEEN,5BU�Ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name toANK PbSly i Case # Q
Date of Cremation 17 —Cy— 012Q0
Time Cremation Started Av, 'r gQ / fM r
Time Cremation Completed p2 eOlJi
Type of Container ,"-- /` RVA:) 1 D
Remarks :
/ c 3 2.M .
Jo2i3 �` ��Mr
3AO
TOWN OF QUEENSBURY �U
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:
Frank P. Meroski
(Name) male
(Sex)
162 Warren ST. Glens Falls, NY 12801
(Street) (City) (State) (Zip Code)
who died on 17th day of September 2001
at 162 Warren St Glens Falls, NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Jodi Jordan P.O. Box 412 Fort Ann, NY 12827
(Name) (Address)
Relationship to the deceased ex wife
Name of Funeral Home Gar-lPten -P-3nle-r—al—HEw
ne
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or Jsn
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
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 not wholly groundless, false or fraudulent.
-6;124� 9"'k Carleton Funderal Home, Inc
(Witness) (Address)
i--'iCr C�' MA-&-- P.O. Box 412, Ft. Ann, NY 12827
(Signature of Relative or Legal Rep. and Address)
Signed on this date: ` / Z G/off