Fish, Audley TOWN OF QU EE B`zl
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEBNSBURY, NEW YORK 12804
(518) 745-4476 (518) 745*-4-477
Funeral Director
Name Auer t BSI.
Case#
Date Of Cremation
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Time Cremation Started ,rp
04
Time C'eemation Completed 11', IU 1+114
Type of Container C���(�, ,
Remarks CA
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Town of Queensbui y
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12W
Cemetery Office:(518)745-4476, Crematorium:(518)745-4477
Authorizatit on to Cremate
The undersigned requests and autlmnM Pine View Crerrrat0m",in accordwvm with and sub)ect to its Rules and Regulations to
cremate the remake of:
Mr. Audley Julius Fish M
31 Vaughn Hudson Falls NY 12839-
(Street) (City) (Stalls) (23p Cam)
who died on f i/T'1` day of 20
Glens Falls Hospital Glens Falls NY
at
(Place) (Address)
Name and address of nearest WAV n ftfl a or name of person mA xx h* cremebar:
Mrs. Nancy E. Fish 31 Vaughn Road
(Name) O
Relafixiship tothe deceesed Wife
Name ofFwm*Hww Carleton Funeral Home, Inc. T_
tJYPORTANT:
I represm that to the best of my I mvAedpe,to dsoee&W(Tres)o&no nreloer,deflb illeilor or any other beft y operated
device in his or her body. (Ckde One)
f rest whet l trove flat power and ral oritretion tp h�elthe buns r akm d or may demboyed,and apse to of ld end and
txemeRed remains.then arty personaF posaesetons
as"hamsters Pkro Wttw CrSma orturn from any artd aN dek. and deer, 14 for foes or den apes which may be►►reds allMnO them
by meson of or eonnomd with the ae-Eft of said►emaire as dtreded,whorl er such eiaYtts or dafnwWs ere or are riot wholly
protndless false or iraudulertt.
(Adftm)
(Signature a"Address of Relative or LOW Rspreserttwmi
Signed on,writs date: j� G� 4.4 .�'�z //'- , „'��"' �
Oislveition of Cranteted RwwS
I hereby direct Nkse View Cremmorium to dispose of the aemeted remains$0 iuNows:
Mall to
Other enangernents-Please apmw
If puhreraation of CMmated remains is requested,elnodc here XX
Revision:January 1,2006