Findlay, Earl TOWN OF QUEE9 5BUImo''
PINE VIEW CEMETERY AND CREMATORIUM
QUAXER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745.4477
Funeral Director G � Z. +Cj
R)-� Caseff'
. 3 �
ate Uf Cremation f ox
Cremation Started
' me Cremation Completed � '� •� '
'VDe of Con tainer(:,4k>-d 30jq
;eMarks
i
i
�3
PINE VIEW CEMETERY AND CREMATORIUM
RECEIPT FOR BODY PURSUANT TO NEW YORK STATE PUBLIC
HEALTH LAW SECTION 4145(2)(B)
1. NAME OF DECEASED AS IT APPEARS ON THE BURIAL-TRANSIT PERMIT
L ��f1iQ5 �7IYPJG,Q y
2. DATE THE BODY WAS DELIVERED
3. NAME AND LICENSE NUMBER OF FUNERAL DIRECTOR OR UNDERTAKER
4. FUNERAL FIRM REPRESENTED BY FUNERAL DIRECTOR OR UNDERTAKER
5. NAME OF PERSON IN CHARGE OF CEMETERY
�),w�
6. SIGNATURE OF FUNERAL DIRECTOR OR UNDERTAKER
7. SIGNATURE OF PERSON IN CHARGE OF CEMETERY
8. NAME OF CEMETERY EMPLOYEE WHO RECEIVED BODY
9. SIGNATURE OF CEMETERY EMPLOYEE WHO RECEIVED BODY
;t
t
t
F
w5�3 C�
TOWN OF bUEENSBURY
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:
Earl C. Findlay male
(Name) (Sex)
?pt. 41 , 325 Broadway , Fort Edward , NY 12828
(Street) (City) (State) (Zip Code)
who died on 27th day of December 2003
at Apt . 41 , 325 Broadway, Ft. Edward, NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Norma Findlay Apt . 41 , 325 Broadway, Ft . Edward, NY 12828
(Name) (Address)
Relationship to the deceased wife
Name of Funeral Home _Gairleten Funeral HeFre Ine.
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 or connected with the cremation of said remains as directed,
whether such claims or demands are not wholly groundless, false or fraudulent.
IAI Carleton Funeral Home, Inc.
(Witness) (Address)
APt. 41 , 325 Broadway, Ft: Edward, NY 12828
(Signature of RelatiV4 or Legal Rep. and Address)
Signed on this date: Dec. 28, 2003