Munger, Frank TOWN OF QUEENSBURY
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbttry, NY. 12804-5902
(518) 745-4476 (518) 745.4477
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Funeral Director: "2-r^-1= �C✓
Name of Deceased:
Case Number: B
Date of Cremation:
Retort:
Time Cremation Started: C)
Time Cremation Completed: C) [ /�
Type of Container: ti tea 4 ✓4
Remarks:
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" Ho )it e of NatltraI Bea itIy ... A Good P I n c e to Live "
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office:(518)745- 476,Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Repuletions to
cremate the remains of:
Frank Munger M
(Name) (Sex)
32 Leonard Northumberland NY 12831-
( ) (may) (State) (Wp Code)
who died on 0 l/14/2 0 0 6 day of 20y___
Residence Northumberland NY
at
(Piece) (Address)
Name and eddress of neereet wft relative or name of person autwrbft cremation:
Mrs. Maxine Munger 32 Leonard Street
(Name) (Address)
ReletioneW to We deoessed Wife
Name of Funeral Home Carleton Funeral Home, Inc. �R
IMPORTANT:
Imposer Out to the best of my biwAedge,the deceased(has)or(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circle One)
I certify that i have hull power and sutrorbstion to arrange for the cremation of the remains and to direct the disposition of the
cremelled remains.that any peraonai possessions hove either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crernovium boat any and all chime and demands for foss at damages which may be made speinet tram
by mom of or corxter tact with the aernatlon of sold ramairis as directed,whether such claims or demands are or are not*to*
ground7
"bless) (ems)
-��&WaW�andddress M Relethto or Lap[ esentative)
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Signed on this date: /St/
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of We cremated remains as follows:
Map to
Oth anwownw"-Please Specify: P,��
er (? u t k y\ T-L,✓ie d CLA 14Z ,
If pulverization of cremated remains is requested,check here XX
Revision:January 1,2006