Hunt, Cynthia TOWN OF QUEEN5oup
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4-476 (518) 745-4-477
Funeral Director 0IcIrCzk F::— *U (q
Case
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Cremation Started
' i7e Cremation Completed
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NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Cynthia lnqp Hunt Fprnalp
Date of Death Age If Veteran of U.S.Armed Forces,
12/08/2003 68 years War or Dates
Place of Death Hospital, Institution or
City,Town)qj()(XIaVI(xXx City Of Glens Falls Street Address Glens Falls Hospital
Manner of Death Z Katural Cause []Accident [:]Homicide E]Suicide [:]Undetermined Pending
Circumstances Investigation
Medical Certifier Name Title
Robert Sponzo M.Q.
Address
102 Park Street Glens Falls,NY '12801
Death Certificate Filed District Number Register Number
City,Town W kVaWKXxx Citv Of Glens Falls 5601 627
Date Cemetery or Crematory
❑Burial
12/10/2003 —Pine View Crematorium
Address
dremation
Queensbury,NY 12804
Date Place Removed
ZF1 Removal
0 and/or Held
and/or —Address
Hold
Date Point of
Transportation Shipment
by Common Destination
Carrier
Disinterment Date Cemetery Address
Reinterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home Carieton Funeral Home,Inc. 00284
Address
68 Main Street Hudson Falls,N Y 12801
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped,If Other than Above
Address
Permission is hereby granted to dispose of the human remains described above as indicated.
Date Issued 12109/2003 Registrar of Vital Statistics NbRd 14 clzcl�/W VIA
N (signature)
District Number 5601 Place City Of G1Pnq F;gllq
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
Date of Disposition Place of Disposition
(address)
(section) (lot number) (grave number)
Name of Sexton or Person in Charge of Premises
(please print)
Body Delivered on Z C. I 20 C
ame) For lt� L'�Fepresenting
(Name)
Carleton Funeral e Inc
Ok C. 4ti r 1 ILLicense No.
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:
Cynthia Eloise Hunt Female
(Name) (Sex)
144 Hendee Rd. Kingsbury,NY 12839
(Street) (City) (State) (Zip Code)
who died on 8th day of December 2003
at Glens Falls Hospital 100 Park Street Glens Falls,NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Richard Hunt 144 Hendee Road Hudson Falls NY 12839
(Name) (Address)
Relationship to the deceased Husband
Name of Funeral Home Carleton Funeral Home,Inc.
IMPORTANT:
I represent that to the best of my knowled e, the deceased has or has no
pacemaker in his or her body. (Circle OneJ
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 n of or connected with the cremation of said remains as directed,
whether uch claims or demands are not wholly groundless, false or fraudulent.
'J � �� 68 Main Street P.O. Box 67, Hudson Falls,NY 12839
(Witness) (Address)
✓J/J N N Ff 6,O,F6 rz 0 f7UyS ow �7q L[S y 12g 39
(Signature of Relative or Legal Rep. and Address)
Signed on this date: 1 � 1 9 JO-)