Londrigan, Ralph S f
T
TOWN OF Q UEENS B UR Y
Pine View Cemetery nod Cremotornum
27 Qunker Rond, Oteenshury, NY. 72804.5902
(5I8) 745.4476 (518) 745-4477
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Funeral Director: (cirIe-4on
Name of Deceased: ;C P
Case Number: 3
Date of Cremation:
Retort:
Time Cremation Started: Liz) y�r✓1
Time Cremation Completed:
Type of Container:
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:
Ralph Richard Londrigan male
(Name) (Sex)
8 Vanderheyden St. , Glens Falls, NY 12801
(Street) (City) (State) (Zip Code)
who died on the 21 st day of July 2005
at Glens Falls NY 12801
(Pace (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Muriel Londri an, 8 Vanderheyden St , Glens Falls , NY 12801
(Name) (Address)
Relationship to the deceased Wife
Name of Funeral Home G--letea Funeral T
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 reas n of or connected with the cremation of said remains as directed,
whethe such claims or demands are not wholly groundless, false or fraudulent.
L'V
68 n St. , Hudson Falls, 1. *a-
(Witness) (Address)
0 ' 8 Vanderheyden St, Glens Falls, NY
(Signature of Relativ (/or Legal Rep. and Address.)
Signed on this date: 7/21 /05