Adams, Gloria TOg4N OF Q,UEEVBU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director CAA\� kA
Name �, 0 d4A5 Case# u q
Date Of Cremation j� — 2 `Z
Time Cremation Started to 5-0 YA� _ L_ ,
Time Cremation Completed :ti0 vo
Type of Container (J1-}eAMZ �W�� C 1fF V� .4,14�1�� � �r} vl/I'�(,�
Remarks
2 014 5C �,G'.��. r -,Vk,
10 4-41
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TOWN OF QUEENSBURY
PINE VIEW CEMETERY 4&lf
,_3
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:
Gloria Jean(Spinks) Adams Female
(Name) (Sex)
507 Allen Road Greenfield, NY 12859-
(Street) (City) (State) (Zip Code)
who died on 18 day of November
at Residence Porter Corners,NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
John Adams 481 Upper Sherman Avenue Queensbury,NY r
(Name) (Address)
Relationship to the deceased Son
Name of Funeral Home Carleton Funeral Home, Inc.
g .T.i.
IMPORTANT:
I represent that to the best of my knowledge, the deceased h :a::s�no
pacemaker in his or her body. (Circle One)
I certify that I have the full power and authorization to arrange for.the crew.tion
of the remains and to direct the disposition of the cremated remains, that any ,
personal possessions have either been removed or may be de royed, and agree
m
to protect, defend and save harmless Pine View Crematoriu _tffirn.ahy and all'
claims and demands for loss or damages which may be made against tRem
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 Stirtr Hudson Falls,. NX 12839
1; i ness) (Address
(Signature of Relative or Legal Rep. and Address)
Signed on this date: f
TOWN OF QUEENSBURY
CERTIFICATION OF CREMATION
PINE VIEW CEMETERY & CREMATORY
This certifies that the remains of: GLORIA J ADAMS
were cremated on NOVEMBER 22 ,2005 atthe Pine View
(Month) (Day)
Crematorium, Queensbury, New York, and these are the cremated remains
of said body.
Date of Death NOVEMBER 5 18 P20 05 Age 57
(Month) (Day)
Funeral Home CARLETON Registered No.: 494
(Authorized Signatur