Boor, John . rro WN OF QUEEN,5BU9zY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745_4477
Funeral Director f z YV
Name�J{-�� �.. �V C� l'C Case # 3
Date of Cremation - �j - ZGG 'Z
Time Cremation Started 7AJ
Time Cremation Completed , \ ✓y\
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Type of Container (fAfA---'tR,d
Remarks :
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:
John L.Boor Male
(Name) (Sex)
216 Aviation Road Queensbury,NY 12804
(Street) (City) (State) (Zip Code)
who died on 20th day of __ August 2002
at Albany Medical Center Albany,NY 12200
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
June Boor 216 Aviation Road, Queensbury,NY 12804
(Name) (Address)
Relationship to the deceased Wife
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or 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.
68 Main Street P.O.Box 67, Hudson Falls,NY 12839
4itness (Address)
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(Signatur lative or Legal Rep. and Address) CuFf.�s,avrr y y
Signed on this, te: 013o /o z