Palmer, Yvonne rroq+N OF QUEEN4,5BUJKY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEEINSBURY, ti'EW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director IWO-ZaIV
Name d/'y O Case # �f
Date of Cremation f /d
Time Cremation Started /OZ Ida, /otm
Time Cremation Completed 62
Type of Containers MkjZ /y
Remarks : ',�,�c
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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:
Yvonne Margaret Palmer Female
(Name) (Sex)
9355 87 Terrace North Seminole,FL 33777
(Street) (City) (State) (Zip Code)
who died on 7th day of January 2002
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:
Earl Trackey 15 Kelly Avenue, Hudson Falls,NY 12839
(Name) (Address)
Relationship to the deceased Father
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or (hasnno
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.
68 Main Street P.O.Box 67, Hudson Falls,NY 12839
2[
Witness) (Address)
(Si nature of Relative or 1-4—al Rep. and Address)
Signed on this date: 0;L00;?