Aitken, Robert r"WN OF OUEE
v -s U
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBVRY, NEW YORK 12804
(518) 7145.4476 (518) 745.4477
Funeral Director `4(l�^�=F_�4
i
_a : e Of Cremation
• .e Cremation Started
:-e Cremation Completed
�e of Container ��' �3 a a tzcl -r ry
:arks
�i FAX 413 549 1118 SINAUER ASSOCIATES INC Q 002
08.52 AM CARLETON FUNERAL HOME FAX:5187461689 PAGE 3
TOWN OF. QUEENSRURY
^` PINE VIEW.CEMETERY
" CREMATORIUM
Quaker ,Road, aueensbury,,'New York 12804
- r'-Plione (51.$) 'Crematorium. 146-4471 or if no answer
Cemetery 745-4476
AUTHORIZATION-TO CREMATE
TH. 'll; i6 pd: requests and authorizes Pine View Crematorium, in accordance with
iar d ::s ,c'i�.E:a.�its Rules and Regulations to cremate the remains of,
Aitken Malc
.St,. CY1ei-is ka11s. NY 12MI-
( Yet— (City) (State) {Zip Code) —
vvli %. � '" 1 !-�u _ day of r January
a - ;:. ;::.•; ;.:Ul.ns Fallc Hospital Glens,Falls,NY�T__�_
', 1ce) (Address)
Na'r�i,-O'n'* dress of nearest living relative or name of person authorizing .cremations.
Vesely ,I91 'Lower Road Deco icld,MA
(Address) _..._
iiltaC 'to,the• deceased Cousin. �-
1 :� -'0,.� 'h:oral Home �..T C;arletan l~cmez�l fioane, I►ic.
I:r {€ ;: l iat to. the best of ,rny knowledge, the deceased has no
i,rat , k Fx..psis or her bbdy. (Circle One)
harrp the:full�p6wer•and autborizatlori to arrange for the cremation
. anca.tod. ird#:tli'e dispdsitiori,of the Cremated remains, that any
3l )' ,>ssssioi,s hjr�e �,:iLher Meer, reii.ove'd or rr► i ce destroyed, and agree
;to�•pr� s; #endrtd savehai~miess Pine View.Crematarium from any and all
mantis.for loss or dernages which may be made against them-
b�¢r:1'bi6,*0 or' connected with th0 cremation of said remains as directed,,
fi Ot..s�.r�t f? claims or demands are not wholly groundless, false or fraudUlant.
68 Main Street, Hudson Fa'lsV Nx 12039
tr]p�ss) (Address)
gia, ure RelaAL
tive-o Legal Rep. and Address)
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