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Wolfe, Lawrence Sr. T07+N OF QUEEVBURY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director 6fA z1 -1� C) Name 1--tia (.y R N C,I� �� l y�)1 �t. S �- Case# Z -), Date Of Cremation CC) Time Cremation Started �'( 0 b )r)' Time Cremation Completed ,b C2 0 Type of Container�Y�� (�l.Uy-tt-r C �� /V1►'3 �1`l— o S' LA) Remarks G As L © V 2 0 1 �CA-'� 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: Lawrence C.Wolfe, Sr. Male (Name) (Sex) 61 DeGroot Road Fort Edward,NY 12828 (Street) (City) (State) (Zip Code) who died on 28th day of February 2003 at 61 DeGroot Road (Place) (Address) Name and address of nearest living relative or name of person authorizing cremations: Rose M.Wolfe 61 DeGroot Road, Fort Edward,NY 12828 (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 S��OD 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 ess) (Address) i nature of Relative or L al Rep. and Address) Signed on this date: _�7 63