Aubrey, Beatrice rrn`wN OF QUEEN5BU.
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEEINSBURY, NTEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director l ag- z l
Name iC'" fe! . L�lJ Case #
Date of Cremation
Time Cremation Started -v P kf y f M r
Time Cremation Completed J`.1
Type of Container ���Q/��D D� G��, Q ' Z2gE-A17191Y
Remarks :
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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:
Beatrice Mae Aubrey female
(Name) (Sex)
20c) r.am=1 i ghter Acres Fort Edward NY 12828
(Street) (City) (State) (Zip Code)
who died on 29th day of October 2001
at Glens Falls, NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Mary A. Woodard, 9 Coriander Dr, Fort Edward, NY 12828
(Name) (Address)
Relationship to the deceased daughter
Name of Funeral Home Ga�-Ieten FuneralVese ine,
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or has n
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 rea on of or connected with the cremation of said remains as directed,
whet r such claims or demands are not wholly groundless, false or fraudulent.
T
C L A 68 Main St . , Hudson Falls NY 12839
(Witness) n(Address)
9 Coriander Dr. Ft Edward 12828
(Sigqpfure of Relative or Legal Rep. and Address)
Signed on this date: 10/30/01