Tougaw, Marion TOWN OF QUEEVBU9Zy
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name Case#
Date Of Cremation — 3 '�_✓�J ��,
Time Cremation Started It 14� N�
Time Cremation Completed t4 ✓ --A
Type of Container (�t'ZP.L!jf ,Jz),, ti-j C_ �'-fir, `.�" n,t j),Zz?.' Ar
Remarks
02
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road, QueensWry, New York, 12W
Cemetery Office:(518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The udersipned requests mid au mdres Pine view Crematorium,in accordance wt h and 1 t 1 w Ito its Rules end Regulations to
cremate the remakes of..
Marion (McDonald) Tougaw F
( )
96 Pettis Rd. , P.OGahsRvb4)at NY 12831
(Street) (CRY) (Swe) (Zip Code)
who died on 31 st dayof March �t20 06
at Saratoga Hospital Saratoga Springs
(Place) (Address)
Name and address of rreereat Nving relative or name of person augxxbkV cremation:
William Tougaw P.O. Box 41
(Name) (Address)
Son
Reiatlonw.p to the deoeasad
Name ofFurerafHoma Carleton Funeral Home, Inc. T_
LYPORTANT:
I rapreserR that to to bear of my browledpe,the dammed(has)or(has no)pacemaker,def b gs or or any other betkVy operated
device in his or her body. (Circle One)
I cw*that t have hA power and auffro OmMon to arrange for the aell10 an or the remains and to direct the dlsposlNon of the
cremated remains,that any pwwnai possessions have either bean removed or may be dewheyed,and agree to protecL defend and
save t nr*w Pine View C mnrawkn from any and aN dakro and 'artrsrds for loss or damage word►may be nwrie speind Umm
bV reason of or co ntar�ed with the aerneron of said remains as directed,whedw such daims or darrierds are or are not wh*
4
.Use or
Carleton Funeral Home, Inc.717 'o
(Address)
A L'^'j � Jam✓►-ram, � !22
(SWtattne and of Relauve or Lagai Repn9aerttative)
Signed on tfds date: 3 f 3 0 6
Dhoosllion of Cremated Remains
I hereby direct Pine View Cremsearbm to dispose of the uemeted►emalrrs as foaows:
Man to
Other arrangements-Please speddfy:
if puivenzoon of cremated rerrnai o Is requested,check here XX
Revision:January 1,2006