Lovering, Diane s
ZO� of QUEEN, B
UP_y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSgURy, NEW YORK 12804
(518) 745-4476 (518) 745-4477
,Funeral Director
f — �aflErt�h
Name �� Lo vo
Case#
Date Of Cremation
C-)b
Time Cremation Started �tf
Time Cremation Completed lapIy
Type of Container �`
cj oc,/�
Remarks
t'Pj
I PUS
------------
I
I
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury,New York, 12804
Cemetery Office:(518)745-4476,Crematorium: (518)745- 477
Authorization to Cremate
The undersigned requests and aulhorizes Pine view Crematorium.In accordance with and st"W to its Rules and Regulations to
Cremate"remains of:
Diane Theresa (Knight) F
( ) � }
5A Oakwood Hudson Falls NY 12839-
("11/03/2006 (CRY) (State)
(zip Co)
who died on day of 20—
Glens Falls Hospital Glens Falls NY
at
(fie) (Address)
Name and address of rreereat NvkV rehom or name of person arrUrorizirrg cremation:
Mr. James Lovering 24 Mohican Terrace
(Name) (Address)
Relationship to the 5 F s S o n
Name of Funeral Home Carleton Funeral Home, Inc. T_
IMPORTANT:
I represent that to the treat of my knowledge,the deceased(has) nos no maloar.delbillsDor or any other bett"operated
device in his or her body. (Circle One)
I owtiy dw i have U power and authorization to arrange for the Cremation of the remains and to direct the disposition of the
Cremated remains,that any persanarl poesessions have either bean removed or mey be destroyed,and agree to protect,defend and
save hanrtless Pkre View Crwmtorkim imm any and aN debot and delnarrds for ices 0f damages which may be made easind them
by reason of or connected with the creotelion of said remains as dlracted,whattrar such claims or demands are or are not vA*
groudiess,WsjW fraudulent. -
(Address)
( a of RelefHe or Rapresartative}
Zon this
Disposition of Cremated Remains
I hereby direct Pine View Cremoodum to dispose of Crertrated mmatr s as follows:
Mail to
Other emangemertts-Please spew.jififAlt _
c
if pulvertration of cremated remains Is requested,check here XX
Revision:January 1,2006