Akine, Ruth "WN OF QUEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
�/� �/ Funeral Director_ ��
Name - 1-11� ��t �✓ Casey
_Date Of Cremation
Time Cremation Started
Time Cremation Completed -AA
Type of Container Gr4z' 1 "QO Pt4 T)
Remarks
ME
EMI
TOWN OF OUEENSBURY
PINE VIEW CEMETERY
• CREMATORIUM
(quaker Road. Oueensbury. New York 121`304
Phone 1518) Crematorium 745-4477 (if no answpr)
Cpmetety 745 4476
AU I I IOR17,A1 ION 10 CREMA I E
The undersigned requests and authorizes Pine View Crematorium. in accordance with and subject
to its Rules and Regulations to cremate the remains of
Ruth B. Akins Female
(NAME) (SEX)
RD 4 Bos 463 Queensbury, New York 12804
(STREET) (CITY) (STATE) (ZIP CODE)
who died on 1 5 th day of J11lle
2003
at Glens Falls Hospital
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Sterling W. Akins
Relationship to deceased Husband
Name of Funeral Home M. B. Kilmer Funeral Home
136 Main St. South Glens Falls , New York 12803
IMPORTANT
I represent that to the best of my knowledge, the deceased has or as n� pacernaMr 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 or are not wholly groundless, false or fraudulent.
(WITNESS) / (ADDRESS)
(SIGNAf URE OF RELATIVE OR LEGAL REP. AND ADDRESS)
Signed on this date: June 16, 2003