Loading...
Sabo, Wendy t Funeral Director: , . 1 1 � Name of Deceased: W 13 G Case Number: 5C Date of Cremation: 7 Retort: t Time Cremation Started: Time Cremation Completed: Type of Container: t4-I ` ' -11 (, Remarks: <�L LOS 6-4-1 10 7 Ocl -j 1�- 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 r The undersigned requests and authorizes Pine View Crematorium, in accordance with and subject to its Ru*sand Regulations to cremate the remains of: _Wendy L- Sabo female i (Name) (Sex) 15A Sixth St. , Hudson Falls, NY 12839 (Street) (City) (State) (Zip Code) who died on 22nd day of June , 2005 at Glens Falls Hospital Glens Falls, NY (Place) (Address) Name and address of nearest living relative or name of person authorizing cremations: Eric Sabo 40 Bluebird Rd #4, South Glens Falls, NY 12803 (Name) (Address) Relationship to the deceased son Name of Funeral Home Ga-.1eten Funeral Hem Inn. 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. pvvl Carleton Funeral Home, Inc. (7itness (Address) 40 Bluebird Rd #4, S. Glens Falls, N+Z 12803 ( g t Relative or Legal Rep. and Address) Signed on this date: