Korinke, Beatrice TOWN OF QUEENSBURY
Pine View Cemetery rind Crematorium
21 Qunker Road, Queenshirry, NY. 12804.5902
(518) 74 5.44 76 (518) 745.4477
http://wNvw.queensbury.net
Funeral Director: �to�•��-r�-o r�
Name of Deceased: ,,f31�H tR yti= o� `� FCC
Case Number: R
Date of Cremation:
Retort: C-R►a W IROtiZJ
Time Cremation Started: y -4-zvL
Time Cremation Completed: ► s
Type of Container: O P 2� 13G4y')-�k-(Vey)r + -r ►J,� S �'�,
Remarks:
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" Howe of Nntitrn1 Benitty ... A COO I P I n c e to Live "'
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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:
Beatrice May Korinke female
(Name) (Sex)
Fort Hudson HCF, Fort Edward, NY
(Street) (City) (State) (Zip Code)
who died on 12 day of August 2005
at Fort Hudson HCF, Fort Edward, NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Karen Howard 14 Orchard Dr. , Quensbury, NV 12Rn4
(Name) (Address)
Relationship to the deceased daughter
Name of Funeral Home Ga;rleten Funeral u 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 reason of or connected with the cremation of said remains as directed,
whether such claims or demands are not wholly groundless, false or fraudulent.
Zce4'
(Witness) ddress)
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(Signature of Relative or Legal Rep. and Address) ahoy
Signed on this date: G