McNelley, Margaret 70 q4N OF QUEEVBUWY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name MAR(q',)rZF—�1 pi t1e L,6, Case#
Date Of Cremation t "Z, 3 L--
Time Cremation Started ; O G M,
Time Cremation Completed
Type of Container CYL�ZC� Gt4 S /na 1\1 CK 10
Remarks
Et (y A-4-1
9 Ll A �
DEC-23-2002 MON 11 :25 AM FAX N0, a
12/23?2002 11:04 5196422322 P. 01 SI C(
R0 ERT M KING, FH •+
PAGE 02
TOWN OF CUE.5NSBURY
FINE VIEW CEMETERY
i CREMATORIUM
Quaker Road, Queensbury,New York 12804
i phone(518)Cremacortum 746-4477(if no answer)
t
Cttnetery 746..44,76
i
AUTHOR17ATION TO CREMATE
i The ur,ders'gn d requests ano authorizes pine View Crematorium.In accords
t
to Its Rules on Regulations to cremate the remains of rice with and subject
i mar gar r. McNea 1 by
{h'A.M )
(SEX)
7? h0rz Street Gr.anvllle
tSTR t:'f) �ewr Y t 1z8
(CITY) { ATE) (ZIP Rot:)
Who died on 22
day of D mbar
i --^---
;�t_,_,_.Tudiat
. 17 Madison St, Granville y�
i
Name and ad ress of nearest living relative or name of person authorizing cremation,
Rallw� Aobat*ts, 25 txateoxn Ad, �Xnan NY 12 03
RetationshiP to deceased
l rdarne of Fungal Boma_R a b a it t r
� 'II r
IMPORTANT'
I rdpresent th t to the best of my knowledgo, the deceased�f or
I body. (CIRC ONE) 1�W DaCemaker in his or her
I certlfy tha,I Have the full power a,td authorization to arrange for the cremation
►erntfect the
d�position of the cremaled remains, that an n of the remains and
Or mt�Y be destroye,,, and agree to rotate, Y P�sryaial posaees;ors hsyt either been
Cramaroriunl�dsrnsnds
rrd any and all claims ant'demand:for fogs or dam
A Q106na And eeve harmless eerie View
egxrinst tF,crn reason of cr connectod with the cesmttlon of sold remolds is directed, whether
eurh Claim, o� are era not wholly groundlesa�iaks or fra d Mgt h�Y directed.
made
1C
l {wit arsyj {aooRt
(t3r`Gf TURF aF�/T�l�4L�LEGAL REP.AND AVDREJS)
Signed on Ihi dafr•:, 12/2 3 10 2
1 f
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