Wright, Isabel -f
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PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Zn'/'/0'0Fx
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Date of Cremation l/ f p2,( aco r
Time Cremation Started ' qQrv\ r
Time Cremation Completed
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02/25/1995 02:41 5187477548 MBK:ILMEP FH PAGE 02
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queenscury, New York 12804
Phone(518)Crematorium 745-4477 (if no answer)
Cemetery 745.4476
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium in accordance with and subject
to its Ruies and Regulations to cremate the remains of:
Isabel S. Wright Ferrule
(NAME) (SEX)
Main Street, Hartford, NY 1283E
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 19th day of November 20 01
at Athol Memorial
nemorinl Hn n i tal ��„hol , h1A
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation=
Kathryn L. Smith, 189 Eastern Union Tpke, Averill Park, NY 12018
Relationship to deceased Niece
Name of Funeral Home M.B. Kilmer Funeral Home
IMPORTANT
represent that to the best of my knowledge, the deceased l a or s 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 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 or are not wholly groundless, false or fraudulent,
WITNESS) (ADDRESS)
(SIGNArURE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: I a O