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Gordon, Marjorie . TOWN OF QUEEN5BU y PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director C"Z'0Er7©!y Name' & Q/Q/� Cra/P � Case # Date of Cremation Time Cremation Started fze -3s- r 1✓) Time Cremation Completed /CXy147J ► t Type of Container '—,L �Q�/�� Remarks : A AQ Az /� Re M Apr , 1 , 2002 2 . 06PM 417 581 0532 No. 5048 r . TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Rd., Queensbury, NY Phone (518) Crematorium 745-4477 or if no answer Cemetery 745-4476 AUTHORIZATION TO CREMATE The undersigned requests and authorizes Pine View Crematorium, in accordant! and subject to its Rules and Regulations to cremate the remains of: Marione Jean Gordon Female (Name) (Sex) Glens Falls, NY 12801 37 Hunter Street(Street) (City) (State) (Zip Code) who died on 30th day of Nrarch 2002 at the Glens Falls Hoopita(Place) 100 Park Street Glens Falls, NY 12801 (Address) Name and address of nearest living relative or name of person authorizing cremations: Terry Hitchcock 2601 South 14th Ave.. Ozark. MO (Name) (Address) Relationship to the deceased son Name of Funeral Home IMPORTANT Carleton Funeral Homo, Inc. I represent that to the best of my knowledge, the deceased has or has 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 not wholly groundless, false or fraudulent. NY 12839 68 Main Street P.O. Box 67, Hudson Falls, (WI ess) ( dress) X (Signature f Relative or Legal Rep. and Address) 2Gv 1 5 1 -A Ave U 41 AA,0 4 S7z.1 Signed on this date: