Swan, Craig z-0 WN OF QUEEMs5BU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director jg �,[� 70-/i
Name G' �� /G. <tj Case # !�
Date of Cremation
Time Cremation Started
Time Cremation Comoleted
Type of Container DBp RD
Remarks :
TOWN OF QUEENSBURY
PINE VIEW CEMETERY J
& /
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:
=—icf Joseph Swan male
(Name) (Sex)
Box 577 Buttermilk Falls Rd. , Fort Ann, NY 12827
(Street) (City) (State) (Zip Code)
who died on 5/1/02 day of
at Glens Falls Hosp, Glens Falls, NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Anita Baldwin, Box 577, Buttermilk Falls Rd., Fort Ann, NY 12827
(Name) (Address)
Relationship to the deceased sister
Name of Funeral Home _ rarl Pion Funeral iOM, me
IMPORTANT:
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
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.
i ( (
Va, 68 Main St. ,
Hudson Falls, NY 12839
(Witness) (Address)
t� Box 577, Buttermilk Falls Rd, Fort Ann, NY 1
(Signature of Relative or Legal Rep. and Address) 2827
Signed on this date: _ 5)2 I G-L