Joseph, Herman OF QUEEN5BU9�yPINE 'VIEW C
CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
�G�iNfGr�
Name �- erm�►n J C,Sc ),
Case# INA,
Date Of Cremation 10 —
� r
Time Cremation Started
Time Cremation Completed 3' �6
Type of Container q cl, L "I it
Remarks
3 17
3 ' �oriy
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11g1
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12&9
Cemetery Office:(518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The undersigned requests and&Awkes Fine View Crematori<ntt,in aoWWW'ce with and WNW to Its Rules and Regulations to
cremate the remains of:
Mr. Herman Howard Joseph M
( ) _ y (SOX)
2529 State Route 4Fort Edward NY 12828-
(Streel) 10/01/2 0 0 6 (ckY) (sh") (23p Code)
who died on day of 20
Residence Fort E war --7T _
at
(ems) (Address)
lVerrre and address of rrcereat NAV rewadre or nerve of person artlh dmV cremation:
Mrs. Doris P. Joseph 2529 State Route 4
(Name) (Address)
Relati0M*6p to the deceased Wife
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
1 rspreserrt that tote best of my bKwAedge,the deceased(has S no) meiaer,dB bWA to or sty oOw batkvy operated
device in his or her body. (Cirds One)
I y that I have U power and audrorfttion to arrange for the cremation or the remelns and to direct the dlsposNon of the
C erngfed remains,that any personal possetsin s have either bean removed or may be deshoyed,and spree to protect deknd and
save harmless PNre View Crerrro/orfisri Mom any and aN daNns and derrrI rig for loss or dernagea wtkh maybe made epeirrat them
by Tess on of or conned ad with the aer.oft of said remains as dkocted,wheff r su ch cialtrs or demands are or are not wh*
grottrtdiess false or tamft L
3 (Address)
(S O MD" of or Legal Repraeeroadve)
Sipped on Art date:
D rtion of Crona0ed Romans
I h weby direct Pine View Cremstorkim to dispose of the aerrreted remains as foliaws:
P"to
OArer arrangement$-Pbaae epedly: _
If pi*adzation of cremated remains Is requested,dvx*here XX
Revision.January 1,2006