Main, Barbara TO"MN OF QUEEVBU9 y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name Bo4RBA)R' �- -NA-- Case# qf
Date Of Cremation
Time Cremation Started 10
Time Cremation Completed
Type of Container (�1 � t -1C'
Remarks
CAzw (�70a J Ij
1 -° 140 �'
Town of Queensbury
Pine Yew Cemetery and Crematorium
21 Quaker Road, Queenstwry,New York, 12W9
Cemetery Office:(518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in acwrdence with and subject to its Rules and Regulations to
cremate the remains of
Barbara Ann Main Female
(Name) (S")
49 King Avenue Hudson Falls NY 12839-
(-Rtrw) (CRY) (Swe) (Zip Code)
who died on 12th dayo{ February 20 06
at
Residence Hu son a is --77Y
(Place) (Address)
Name and address of treateet Nvkg felatire or name of person authortdrrg crernetran:
Mrs. Linda Albrecht 49 King Avenue
(Name) (Address)
Rekttlorwtfip to the daceaead Daughter
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
1 represent that to the heat of my b owledge,the deceased(has) (has fro) ,ds11 WA for or any other battery operated
device in his or her body. (Circe One)
1 cw*that I have tug power and atft rtrrtion to arrange for the crewakin of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either bean removed or may be destroyed,and agroe to protect,defend and
save truer km Pkw View Cremetw1um from any and aN claims and demwWs for loss or deraages wtich may be made against them
by reason of or corxracied with ttte cremation of said remains as directed,wtwffw such dainrs or dernends we or are not wholy
grotxtdless,false or fraudulent. A
S / 68 Main St. Hudson Falls
(Address)
49 King Ave, Hudson Falls, NY
(Signature and Address of Relative or Legal RepresentmWe}
Signed on this date: 0 2/12/2 0 0 6
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as folkms:
MaN to
Otherarrangamenls Pleaeespecify: Pick up by Carleton Funeral Home, Inc.
if pulvertzation of cremated remains Is requested,check here XX
Revision:January 1,2006