Greene, Edna rl-n'74N OF QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Date of Cremation 4'S— �-D(/ L)
Time Cremation Started
Time Cremation Completed
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Remarks :
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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:
Edna Greene female
(Name) (Sex)
48 Montray Rd . Queensbury, NY 12804
(Street) (City) (State) (Zip Code)
who died on the 16th day of August 2004
at Glens Falls hospital , 100 Park St_, Manc Paliss.,_NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Eunity Greene, 270 Meadowbrook Rd . , Queenshury , NY 1219n4
(Name) (Address)
Relationship to the deceased sister
Name of Funeral Home Gw--lete , 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,
wheth r such claims or demands are not wholly groundless, false or fraudulent.
IWitness) (Address)
�a--e 270 Montray Rd ,
—r-- (Signs re of Relative or Legal Rep. and Address)Queensbury,
Signed on this date: t 16
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