Horning, Peter L _r
TO UN OF QUEEVBUf�yPINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director fc-,*a f v�
Name p aC, Case# t
Date Of Cremation L4 4e - --xce`, (1
Time Cremation Started —3y al."Z' L
Time Cremation Completed 1i�,-'�'(r"�,
Type of Container �'�/{ ?d�i'�"�£e.1t;2,�
Remarks
V
Town of Queensbufy
Pine View Cemetery and Crematorium
21 Quakes Road,Queensbury,New York, 12804
Cemetery Office: (518)745-4476,Crematorium:(518)745.4477
Authorization to Cremate
The uxrdersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Peter Alex Horning M
(Name) (SOX)
98 Oak Hudson Falls NY 12839-
(Stree!)0 4/0 4/2 0 0 6 (CRY) (State)
(Zip Code)
who died on day of 20—
Glens Falls Hospital Glens Falls NY
at
(Piece) (Address)
Name and address of nearest Wing rrrt0w or name of person authorir*V cremation:
Mrs. Donna Horning 98 Oak Street
(Name) (Address)
Rerations hip to to deceased Wife
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the beat of my loww0ledge,the deceased(has) (hoer rho) rtnalcer,deftilletor or any other battery operated
device to his or her body. (Circle One)
I Wtify that I have Tait pwrer and sutrortra"on to arrange for the cremation of the remains and to direct the dlspOWM of the
cremated remains,Mist any pe wwW possessions have either bean removed or may be destroyed,and apse to protect,delbnd and
save harmless Pine View Crsmetwkn from any and air dskrhs and danhartds for Iris or deraagm witch tray be made spskhst ttmem
by reason of or connected with the cremaion of sold remake as ditected,vMte w such deice or demands are or are not wholly
lent. Sl U L alk ,,( tit
? } (Address)
(Signature and Address of Reftive or Legal Representative)
Signed on this dote:
Disposition of Cremated Remains
I hereby direct Pine View Cremsoxtum to dispose of the cremated remains as fdbrrs:
Man to
Other arrangements-Please speciry:
If puiverktation of cremated remains Is requested,check hers XX
Revision:January 1,2006