Graves, Garfield rl"'o wN OF QUEEN,5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ��rI t",,
Name /—�r{�r��� �S Case# 37a
Dace Of Cremation C6 - da — v(v
Time Cremation Started 12 : y f7�
Time Cremation Completed 5•(b P
Type of Container
Remarks
2' 4(
M�
Town of Queensbury
Pine Yew Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12W9
Cemetery Office:(518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests aid M*Kgt M Pine View Crematorium,in accordance with and suhJecx to its Rules and Reguiations to
cremate the remains&
Garfield Frank Graves M
( ) (S")
Fort Hudson HCF Fort Edward NY 12828-
(Street) (City) (State) (Zip Code)
who died on 2 0 t h of Au u s t 20 0 6
FORT EATbrt E warcT �Y
at
(fie) (Address)
Nerve and address of nearest Nving n ftvm or name of person augwmw g cremation:
David Graves 14 Keenan St. , Glens Falls, NY 12801
(Name) (Address)
Relationship to the deoeasad
Son
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I rap msen t that to the hest of my Ivnowiedge,the deceased( �m� .deftWo or or any other battery operated
device in his or her body. (Cade One)
I certify that i have fait power and authartwtion to arrange for the ommation of the remains and to direct the disposition of the
cremated remains,Mrat any personal po mom ssi r 1 have either beam removed or may be destroyed,and agree to protect delbnd and
aave harmless Pine View Cronnetortum from any and aN dakns and dernsrids for ions or damages which maybe made against fmm
by reesson or connected vAh the cremation of said remains as directed,whether such deems or demands are or are not w h*
or ftwxylga.
Carleton Funeral Home, Inc.
(Witness) (Address)
14 Keenan St. , Glens Falls, NY
'(SWvWm and Address of Relaflve or Leo Representative)
Signed on this date: August 20, 2006
Disposition of Cremated Remains
I hereby direct Pine View Cremetorknn to dispose of the cremated remains as folbws:
Man to
Other arrangements-Please specify: _
if pulverization of cremated remains Is requested,shack here XX
Revision:January 1,2006