Hosler, Airastyn OF QUEEN5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_`\
Name I 14�"( �/� 1y 7LAR—Caselru
Date Of Cremation e71 _ ZUd .3
Time Cremation Started
Time Cremation Completed -13NL
Type of Container (,'fir'\-A-d'(3Q4(2.r) -Sj\,op, 1 /k1,q
Remarks
A4,9tl-e-J
TOWN OF QUEENSBURY
PINE VIEW CEMETERY
8
CREMATORIUM
Quaker Road. Queensbury. New York 12804
Phone (518) Crematorium 745-4477 (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:
Airastyn Genevieve Hosler Female
(NAME) (SEX)
147 Sanford St Glens Falls, NY 12801
(STREET) (CITY) (STATE) (ZIP CODE)
who died on Eighth day of July 20 03
at Glens Falls Hospital, 100 Park St. Glens Falls, NY 12801
(PLACE) (ADDRESS)
Name and address of nearest living relative or name of person authorizing cremation:
Carter John Hosler
147 Sanford St. , Glens Falls, NY 12801
Relationship to deceased
Fa i.iiCi
Name of Funeral Home M.B. Kilmer
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 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 Orconnected with the cremation of said remains as directed, whether
such claimS or demands re are not wholly groundless, false or fraudulent.
(WITNESS) (ADDRESS) '
(SIGNATURE OF RELATIVE OR LEGAL REP. AZ ADDRESS)
Signed on this date:�� Q