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Murphy, Mary OF QUEEN BUJKY PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURy NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director__ 159ew�� a m e �'/, ' V �M U )i —RPCa s e;� '`ate Uf Cremation T=me Cremation Started Time Cremation Completed 1 O 'ell Tvpe of Container Remarks TOWN OF QUEENSBURY PINE VIEW CEMETERY CREMATORIUM Quaker Road, Queensbury. New York 12804 Phone (518) Crematorium 745-4477 Of no answeri Cemetery i45-4476 AUTHORIZATION TO CREMATE The undersignec eauests and authorizes Pine View Crematorium. in accordance with ano subject to its Rules ana Regulations to cremate the remains of: ma (NALA E: (SEX) dc)k N S-- S©L)+P1 k Ia-0 (STREET. (CITY) (STATE) (ZIP CODE) nno died on I day of�e,(TtC_►y�(/�� 20 (7.3 at P, t (PLACE': (AD RESS) Name and address of nearest living relative or name of person authorizing cremation: All Ce— MuroV\ki It Motw4a.te) �tcw Or . 2( Gien Relatinnshin to deceased Name of Funeral dome BRENER FUNERAL HOME, INC. IMPORTANT I represent that tc the best of my knowledge, the deceased has<rhas no pa em ker 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 reas of or connected with the cremation of said remains as directed, whether �strch-� ims or demand r are not wholly groundless, false or fraudulent. (WITNESS) (ADDRESS) , J (SIGNAT 'RE OF RELATIVE M LEgAL REP. AND ADDRESS) Signed on this da:.?: q , LS lo3