Schwaeble, Henry OF QUEENLU
1�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1 t
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Name Hv r -
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Date Of Cremation 2 - t
Time Cremation Started j,. ? s-
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Time Cremation Completed_ j�: jc,
Type of Container cc, rc, L(Arv' J 1 4-t=
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 authortzas Pke View Crematorium,In a000rdanoe with and&Med to Its Rubs and Regulations to
cremate the remains
c � C 13 be
tier)
'
(Street) (CRY) ( Code)
who died on 2- day of z 20 O
(Place) (Add)
Nerve and of 8v(ng relatitre or Warns o//fo�p,arson
J —a6 V' �r
(Name) (A )
ReWdoramp to the deceased
Name of Furerd tome
IMPORTANT:
i represent that to ft hest d my knowledge,the deceased(has) (has no) steer,defxNalor or any other batlsry operated
device Inhis or her body. (Circle One)
I certify that I have full power and ardtmkinorr to arrange for the cremation of the remetne and to direct the disposition of the
cremated remake,that any personal posseeclrts o have atiher been removed or may be destroyed.aid agree to protect,defend and
save harmless Pine View Crematorium ban any and all chins and denmr&for loss or dernages wHdr may be merle against them
by -ar oonnecled wNr the aamallm of sold nemalrra ea cl o ri erl,whether such claims ordw-w ere or are Trot wholly L
(Addtt�ss)
( and Address of or Low Represerwive
Signed on dft dete: 2-7
Disposition of Cremated Remake
I hereby direct Pine View C ramaWum to dbpose of the cremated rem as Maw
Mail to
other artangemergs-Please specly
if pulverization of cremated remake is requested,deck here
Revislon:Jammy 1,2006