Hawley, George ( rOcl4N OF QUEEVBUJZy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director Cti�ltfv►�
Name C eJ� �-a,,✓ l Case# qt-3
Date Of Cremation IV A /U�
Time Cremation Started 1.` q (, Q nn
Time Cremation Completed j7 �aO
Type of Container cc, (- d -rrgv�..�
Remarks
C'rlv� vf�id n1v�tY Iy 5- AM
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10-05-' 05 15:20 FROM- T-336 P002/002 F-1104
Agtoaf4wa zi:zz VAX 5187401660 CARI.B"N FUNERAL 110118 L1 I�
TOWN OF Q.UEENSBURY
PINE VIEW CEMETERY
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (8181 Crematorium 745-4477 or If no answer
Cemetery 7415-4478
AUTHORIZATION TO CREMATE
The undersigned requests and authorizes Pine View Crematorium, In accordance with
and subject to its Rules and Regulations to cremate the remalne oft. •
Earl Hawley Male
(Name► (SOX)
2201 Vernon Trenton MI 48813
(Street) (City) (State) (alp odel .
who died on �'`�`� day of
at L NY
(Place) (Address)
Name and address of nearest living relative or name of person suthonzIng cren cations:
Anna May Hawley 2207 Vernon; �'renton, Michigan 48183
(Name) (Address)
Relationship to the deceased --- - Wife
Name of Funeral Home Ma3;4aUson Eunerah H
IMPORTANT -
I represent that to the best of m knowledge, the doesas�►. T, ,
pacemaker in his or her body. (Circle One k •
I certify that I have the full power and authorization to arrange 1 ' t n
of the remains and to direct the disposition of the cremated reme ` nil
personal possessions have either been removed or may be destro da
to pprotect defend and save harmless Pine View Crernstoriw+n
olelrns ana demands for loss or damages which may be me
by reason of or connected with the cremation of said re
whether such claims or demands are not wholly groundless, fals147171—
(Witness) (Address)
-All '
(Signature of Rdletive or Legal Rep. and Address