Zamora, Isabel e
707tiN OF QUEEVBUr�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QLtENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name —�- {
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Date Of Cremation _ �t
Time Cremation Started
Time Cremation Completed
Type of Container( ,A-.; )i11 r
Remarks
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium; (518)745-4477
Authorization to Cremate
The undersigned requests and a dxw&es Pina View Crematorium,in accordance with and subject to Its Rules and Regulations to
cremate the remains of:
Mrs. Isabel Zamora (Zamora) F
(Name) ( )
The Orchard Granville NY 12832
(Street). (City) (fie) (Zip Cam)
who died on b IN /I°6 day Of
(fie) (Address)
riarrne and address of neereat living reslative or name of person auboroang cremation:
(Name) (Address)
Relationship to the deceased p 94e.'c
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I►epresarrt that to the best of my loiOwledge,the deceased(has)OK >as no cenrelaer,dBflbr111bW or any other bslloy operated
device in his or her body. (Crude One)
I Certify Viet I have tug power and 91810rrzatim to arrange for the cramation of the remains and to d red the disposition of the
rnsmated remains,theft any Prrrsonai possesOMW have either been M Wved or may be destroyed,and agree to protect,defend and
save harrrrbss Pine View Cromelatum Iran any and ag c hkrne and demands for loss or deraagas wfich"be made Spinal them
by reason of or connected with the cremation of said rerttatris as directed,wtneeter such ciaitns or demands we or are not wholly
groundless,false or f tent.
oe
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IV (Y i ness) (Address)
x _).�inr P 1Z) YY);) "A
(Signature and Address of Relative or t.eW Representative)
signed on this date: :am 1 �� ' JY
Disposition of Cremated Remains
I hereby direct Pine View Cotmu torfum to dispose of the cremated remains as foyaws:
Mall to
OUrer envvements-Pbase spedfy:
If puiverbation of cremated remains Is requested,Check here XX
Revision:January 1,2006