Sheridan, Sandra TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
21 Qunker Rond, Queensbury, NY. 12804.5902
(518) 745.4476 (518) 745-4477
hirp://wNvw.queensbury.net
Funeral Director: L la-Vz L,9A 0 t
Name of Deceased: -7)i2 r\ k,, ER -C) Ell
Case Number: 3 Q.C-0
Date of Cremation: `6 - 3 0 — 2 G o's
Retort: CAS u, Q)Lz
Time Cremation Started: n 35 4�
Time Cremation Completed: l rz-1� 410V
Type of Container: (-Ak-yz� a-Ovid
Remarks:
440 44-
Cj
Ct C
" Howe of Nntitrn1 8enuty ... A Good Place to Live "
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:
Sandra Sheridan Female
(Name) (Sex)
Indian River Rehab &Health Care Argyle,NY 12809-
(Street) (City) (State) (Zip Code)
who died on 25 day of August
at Glens Falls Hospital Glens Falls,NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Joanne Williams ,
(Name) (Address)
Relationship to the deceased Sister
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or fhaso
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.
68 Main Street, Hudson Falls, NY 12839
(Witness) (Address)
of Relative o Legp. and Address)e
(Signature
Signed on this date: '�v 0 5'
A
f .
0.n
.�v