Morse, Rhoda F
TO`7'1 N OF QU EEN5BU
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PINE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, Qi,1F.F-NSgURy, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_ I "!
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Name
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Date Of Cremation
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Time Cremation Started 1.16
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Time Cremation Completed
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Type of Container
Remarks
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Tmm 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 undersigned requests and aultxxtzes Pine View Crematorium,in accordance with and subject to is Rules and Reputations to
cremate the remains of
Rhoda Mary (Carpenter) Morse F
(Na") (Sex)
County Rte 41 Hudson Falls NY 12839-
(Street) (City) (State) (zip Code)
who died on 2nd days November 20 06
at Glens Falls Hospital Glens Falls NY
(Place) (Address)
Marne and address of nearest Ruing rewtve or named person authoring cremation:
Edwin E. Morse 681 County Route 41 Hudson Falls, NY
(Name) (Address)
Relatlrxwhip tothe daoeesed Husband
Name of FuneralH(m Carleton Funeral Home, Inc. T_
IMPORTANT: I- --'\ \.
1 represent that to the best of my bowledge.the decessed(tremor(has no)pacemeW.def lillstor or any other battery operated
device in his or her body. (Circle One)
I cony diet t have full power and sudwrtzation to arrange for the cremation of the remains and to direct the dlspoeltion of the
cremated remains,fist any personal possessions have ether bean removed or may be destroyed,and apnea to protect,defend and
save harmless Mine View Crew awdum from any and all Gskrra and demands for loss ar damages which may be made against them
by of or oorxradn wbh fie asmom of said remains as directed,w helhe►suds dates or demands ere or are rot wh*
grogrddle ,false or fraudulent.
(witness) (Address)
(Signature and Address of Relative or Lags[Representative)
Signed on thfyr date:
Disposition of Cremated Remains
I hereby dared Pins View Crematorium to dispose of the aenreted mmains as follows:
Mail to
Other enangerner"-Pbese spew. _
If pulvertzation of cremated remains Is requested,dradc here XX
Revisor:January 1,2006