Sawyer, Christine �4
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OF QUEEN,5BU9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Name_
Funeral Director_ C-1(-I'd,,
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Case#
Date Of Cremation
Time Cremation Started
Time Cremation Completed 6
Type of Container II g i t
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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 udersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remalns of:
Mrs. Christine Sawyer F
(Name) -- -- (SOX)
116 River
(')10/08/2006 (City) (State) (Zips)
who died on day of 20—
Residence Queensbury NY
at
(I'llace) (Add)
Name and address of nearest living relative or name of person authorizing cremation:
Robert Sawyer 116 River Street
(Name) (Address)
Relationship to the deceased Husband
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
1 represent that to the best of my l knowledge,the deceased{has (has rho rev,deflbrNlator a any other battery operated
device in his or her body. (Circle One)
I cer*that I have full power and suffKAration to arrange for the cremation of the remalrts and to direct the disposition of the
cr elated remains,on*any personal possessions have either bean reagved or mey be destroyed,and agree to protect,defend and
save harmless Pine View Cremator l m from any and all Balms and demands for loss or damages wNch may be made against them
by reason of or connected with the cremation of said remains as directed,whalfie►such claims or demands are or are not wholly
groundless.pse or fraudulent;
(Witness) (Address)
( arras and Address of P#wm or Legal )
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine Mew Crematorium to dispose of the cremated remains as follows:
Mal to
other arrangemerits-Please specify:
if puivertzafion of cremated remains Is requested,check here XX
Revision:January 1,2006