Browne, Mary rrOcl4N OF QUEEVBW�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
r Funeral Director
;game � �� 1�"( fcal�ZC)(pJ l�$1 Case#
Date Of Cremation — Z—': (;0
Time Cremation Started b �. j :
Time Cremation Completed 9-
Type of Container GtA1/L�
Remarks
Z I 114 v4- IN l
(f— vs.s .mac C I_ o
,r7
1 10 51:v r!
1 l—
02/04/2r006 01:32 FAX $187461689 CARLETON FLrNERAL HONE 0 003/003
Town of Queensbwy
Pine View Cemetery and CrernakWum
21 Quaker Road,Queensbury.New York, 12804
Cemetery Office.(518)745-4476,Crematorium: (518)745A477
Authoriza6w to Cremate
The wWeraWM rtrguesb end autllorit es Pine Ymw Crematorium,in eowrdenoa with and wbjoct to Its Rules and Ragul*m a
awsle the rema)ns of
( ) (SM)
Indian River NH Granville. NY__ 12832
(Swee) (cky) (So") VIP Code)
whodsdon 4th day of „February 20Q.f.
d Tndj an R;ver Nei, 17 Nadison St., Gr-&Ayille-r- NY 12832
(PIacs) (Ad W")
Name and address of new riving r wft or Hanle of person+aMln **v pamadon:
Mrs. Catherine_ W41,ke ,gf5 WT.F, I.rire rain vn 38436
(Norne) O
Relelionsiti-b ltre deceased niece
NemacfFurlsnlHome Carleton Funeral Home, T_nc_ _
IMPORTANT;
I rppraserlt that to the bast of my Ivlawledge,the deceaIDed(has)or(has no)Pew.�or srry ether treMery operated
device in his or her body. (CNde One)
I comfy tires I have WI►power and aulhoftation to arrange for the con aft d the rea►sins and to diet Bra deposition of the
cararnsW reealrW to any personal possessions helve eMter been removed or may be dewaye&arnd agree to prow.doW and
save harmless Pint View Ccernsw rrn kom any and all chime and demands fbr loss or damages%*rich nsy be made agahtst then►
by dor eonnec led with the aarroson of said remains as di erled,whwrer ash dolons or demands ere or are not wholly
Use orOn trlant_
C.
/ ( (Address)-
,p� 365 WLE Lake Ariel PA 18436
(Slgnows and Ad*m of Relotive or t agsi Repeesrli aNe)
Signed on Oft dolls, February 4, 2006
I
Dlgppsklon of Crernaled Remains
I hereby dared Pure VIEW CMMMWiun b dispose of the cremated rer011111 s as UMW.
tiled b
Dow wrongernenrs-Please sPedry
If p o4orttation of cremated remaft is requested.check here
Revl0on:Janr,ery 1.2DW
02/04/2006 01:32 FAX $187461689 CARLETON FUNERAL HOME 0003/003
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Office,(518)745.4476.Crematorium: (518)7454477
Authorization to Cremate
The uncle skned requests and authorizes one view Crematork,m.In eccordwic a with and%d*ct to its Rules and Regtdadom to
cremate the remains of:
Mary F.7 i 2abeth Rrnwnrs
(�) (Sax)
Indian River NH Granville, NY 12832
(street) (Cry) (tee) (2v Cam)
whodledon 4th day of February 200-5-
at (Ph")fin i ver._NH. ' 1'oss_St , ���nyi•lle, NY 12832
Name"address of nearest wing mu tive or Hanle of persw authorizzingcramation,
Mrs. Catherine Wilke ,365 WT.R0 Lake Ax:iel RA 38436
(Name) ( )
Relationship to Iho deed_ n i e ce
Name of Funeral Home Carleton Funeral Home„ Tn
IMPORTANT.
I riepresem that to the bast of"Ioaawledge,the deceasW(has)or(fleas rat paoem*w,deft 0stor or mry other battery operated
device in his or her body. (Circle One)
f aerdfy that I have fall power and authortzatlon to arrange for the Cremation of the remahs and to direct the disposition of the
uemated ramalM that any personal possessions have alther bean removed or may be dearoyed,errd agree to protect.defend end
save harts Pine View Crematorium from my and all dorms and demands for loss or damages wfrch maybe made agabm them
by i@qn of or c onneded with Me cremation of sold remains as directed,whether�t cht4trs or demands ere or are not wh olly
flp�p�Y C./` .tefEe ulanL
C Or Ca ea H Carleton unrnmp, TnC.
( (Vlfitttessk (Address)
365 WLE, Lake Ariel, PA 18436
(Slgnawre and Address of Relative or I.eyal Represerftatf m)
SIgnedan Oft date- February 4, 2006
1
Dlepceltlon of Crammed Remahs
I hereby direct Pine View Crematorium to dispose of the creamed mmebas as follows:
map to
Other arrangements-Ptesse spedty:
If pulverization of cmmarod remains is requested.Check hem
RevWn.January 1.2W6
T •d 0T2L6890LS
eL0 =0T 90 SO qaj