Atkinson, Malcolm TOWN OF QUEENSBURY
Pine Viety Cemetery nrtd Crematorium
21 Qunker Rond, Queensbury, NY. 72804.5902
(518) 745.4476 (518) 745.4477
http://wNvw.queensbury.net
Funeral Director: C 1k xz I r-A-0 N
Name of Deceased: CAI-X-Q�-AA, T-
Case Number: S Ce
Date of Cremation: _ - � - 7-4VIC,
I
Retort:
Time Cremation Started:
i
Time Cremation Completed: �1�, So a�'
Type of Container:
Remarks:
31 � y �ti I
to t°-21
i
" Home of Nn tit rnI Ben it ► y ... A Gooi1 PInie to Live "
� s4
TOWN OF QUEENSBURY a
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:
_ Malcolm J. Atkinson male
(Name) (Sex)
451 Gilchrist Hill Rd, Hartford, NY 12838
(Street) (City) (State) (Zip Code)
who died on 17th day of August, 2005
s
at Samuel Stratton Albany VA Hospital
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
I
Marlene Moore, 432 Gilchrist Hill Rd. , Hartford, NY 12838
(Name) (Address)
Relationship to the deceased daughter
Name of Funeral Home
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 temains as directed,
whether such claims or demands are not wholly groundless, false or'fraudulent.
I
Carleton Funeral
(Witness) Z�—�
(Address)
432 Gilchrist Hill rd, H
(Signature of Relative or Lep. an Address) Hartford, NY
Signed on this date: 8/18/05 j
9 i
TOWN OF QUEENSBURY
CERTIFICATION OF CREMATION
PINE VIEW CEMETERY & CREMATORY
This certifies that the remains of: MALCOLM J ATKINSON
were cremated on ATTcTTST 9 ,2005 atthe Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains
of said body.
Date of Death ATTCTTST , 7 20 05 Age 85
(Month) (Day)
Funeral Home CARLETON Registered No.: 356
G ' �
(Authorized ignature)