Caprood, William OF QUEENB21
P,
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director C,A IQtC-*.
Name CID(OL, i Case# 3�L�
Date Of Cremation
Time Cremation Started 5? Z
Time Cremation Completed jp ' Lb
Type of Container IST CASE
Remarks
1-1 A I t\) 9 35 Am �
(`j
CC LI �wi� Ly
Town of Queensbtfry
Pine Yew Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The urndwsign Wd requests and&Owrizes Pine view Crematmum,to a000rdance with and su*d to its Rules end Regulations to
cremate the remains of
William Caprood M
(Name) (SOX)
61 East (. A $,4r,1-5E Hudson Falls NY 12839-
(9treet)0 8/2 4/2 0 0 6 (City) ( ) (Zip Code)
who died on day of 20�
Residence Hudson Falls NY
at
(Ptaoa) (Address)
Name and address of rreereat living relative or name cf person autlxoriWng cremation:
Mr. William Caprood 61 East LaBarge Street
(Flame) (Address)
ReMbons*I;D the deceased Son
Name of Funerat Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my bwwledge,the deoeasad(has)or(has no)Pacemaker.del b 0ow or any other battery operated
device in his or her body. (Circle One)
I oe*that I have fug power and authorization to arrange for the cremation of the remains and to direct the dlsposNon of the
cremated remains,M hat any personal possessions have either bean ranxived or may be destoyed,and agree to protect,defend and
save harmless Pine View Crwmtatixn from any and A dains and demands for loss or damages which may be made aombld them
by reason of or connected with the cremation of said remains as dientad,wttaltner surh cieims or demands we or are not w h*
pmundless,false or ffauduh nt.
D&zz,j A JA,
(witness) (Address)
(SWatur/e�and Address of la"or Lega/l-Representative)
Signed on this date: 'i( 2 t ZQ O w
Disposition of Cremated Remains
I hereby direct Pine View Crermmodurn to dispose of the cremated remains as follows:
mem to
odw arrangements-Pbeae specify:
If pulverization of cremated remains Is requested,chock here XX
Revision:January 1,2006