Boisclair, Joseph TOWN OF QUEENSBURY
Pine Virtu Cemetery nnrl Crentntortum
27 Quaker Road, Queenshttry, NY. 12804.5902
(518) 745.4476 (518) 745-4477
htrp /iw\vnv queensbury net
Funeral Director: / V L r, C'�-1 LL t�'. V- (
Name of Deceased: 0c7 y K Abe,-
Case Number:
Date of Cremation: - 1 200
Retort: (LV.A W�--Q P-�
Time Cremation Started: Jc' Ilk Z'l,
Time Cremation Completed:
Type of Container: Gva\7-D 13d14C-2-3-
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Remarks:
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-itt3/23/2007 09:10 516-74 -�}47v T 0 '-',jEE'6BlJF.Y PAiiE 02
TOWN OF OUEENS6URY
PINE VIEW CEMETERY
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CREMATORIUM
Quaker road, Queensbury, New York 12804
Phone(5181 Crematorium 745-4477(it no answer)
Csmetery T45-4476
AU�HORI7-ATION TO CREMATE
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The undersigned requests and authorizes Pine View Crematorium, ir, accordance with and
subject to its Rules and Regulation to cremate the remains of: �/
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® (NAME)// (SEX) �/ dy�
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(STREET) (CI Y) ( T TF) (ZIP CODE)
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who died on_ _ _ day of �/�L!_. iP 20C:P
at_/ V .---- 1& e
a (PLACE) (AESS)
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Name end address o`nearest living�elative or name of person authorizing cremation:
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Relationship to deceased _�••,/ob(_
Name of Funeral Home__ 114
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IMPORTANT
I represent that to the best of my kn wledge, the deceased has or h n acemaker in his or her
body. (CIRCLE ONE)
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certify that I have the full power an j authorization to arrange fpr the cremation of the remains
and to direct the disposition of the criemated remains, that any personal possessions have either
?Pen remit ,!ATH Dr r•,a,,he destreved.l and agree to protect, defend and save harmless Pine VWA
Crematoriurn frern any and all claim and demands for loss or tWrrages which may be made
against them by reason o`or connected with the cremation of said remains as directed.whelher
such claims or dwuonds are or are r►ot wholly groundiess,faise or I,ouc.Iulent.
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w (VViTN eSS) (AgL;RESS)
(SIGNATURE OF RELATIV OR LEGAL RFP-AND ADDRESS)
Signet;on this date:_ a _
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