Russell, Lucille T07+N OF QUEEN,5BUjr�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
1
Funeral Director
Name L �i► I �e � � �� Case# '>32
Date Of Cremation 7-
Time Cremation Started__ ►� . � ��
Time Cremation Completed P 7
Type of Container 'Ah�:���� �t �� (5i Ckbit-
Remarks
30
3. c� �'►"1
33a
Town of Queensbtmy
Pine Yew Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12WW
Cemetery Office:(518)745-4476,Crematorium:(518)745-4477
AudWzafw to Cremate
The undersigned requests and audmi¢es Pine View Crematorium,in accordance with and subJec:t to its Rules and Regulations to
cremate the remains at
Lucille Marie Russell F
17 Park Queensbury NY 12804-
("07/15/2006 " 4 Mae) (Zip Code)
who died on day of 20—
Glens Falls Hospital Glens Falls NY
at
Name and address of nearest Nvirtg reWhe or name of person aulhort&q crentaGrnr:
Mrs. Marie Bocchi 54 Grant Avenue
(Name) (Address)
Relatim01 tip tothedeceased Daughter
Name of Funerai Home Carleton Funeral Home, Inc. T_
LUPORTANT:
1 raprrea m that to the Wool nW ba wiedpe,the deceased(has)or(has no)peoe w1w,deftiOpim or any other bettbnyr operated
device In his or her body. (Cards One)
I cerdtf that t have tut power and aL*Kw vft n to arrange for the creme0on at the remakes and to dkect the disposition of the
cremated remains,Mist any personal possessions have either been removed or may be destroyed,and agroe to protect,defaid and
save harmless Pine View Creme%xiurn from any and aN dairrrs and rler-a rim Tar toss or damages wtdrh mey be made apakst them
by,eaw of or connected wkh Ute aerrrwft of said rametrts as dTh a ch d,wheOw suds maims or Take or ftauduWt a or are not*A*�� N- a� ,&
er
7
!, �)
' '
771
)
(geese atd%4drass of Reladve or LOWRive)
Signed on this date: / e C)
Disposition of Cremated Remains
I hereby direct Pine View Cremalorirsrt to dispose of the cremated remains as blows:
MaN to
other arrangements-Piame spow.
if prgvaruW"of cremated remains is requested,dracic here XX
Revision:January 1,2006