Oliver, Jacqueline TO r N OFQUEE9�5BU-9�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW YORK 12804
(518) 745-4476 (518) 745-4.477
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Date Of Cremation 1-1 - ILI_ Off,
Time Cremation Started 7V 5
Time Cremation Completed
Type of Container c �
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Remarks
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Town of Queensberry
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12WK
Cemetery Office:(518)745-4476,Crematorium;(518)745-4477
Authorization to Cremate
The undersigned requeats and authorizes Pine View Crematorium,in a000rdarnoe with and subject to its Rules and Regulations to
cremate the remakes of:
Jacqueline Anne (Murray) Oliver F
(Name) (sex)
46 McIntyre St. Fort Edward NY 12828
(Street) (CRY) (fie) (zip Code)
who died on 9th daYof December 2006
Glens Falls Hospital Glens Falls NY
at
(Place) (Address)
Name and address of nearest Wing restive or name of person aL*wrb*g a m.atian:
(Name) (Address)
Rekdici alrip to the deceased -
Name ofFur>eratHome Carleton Funeral Home, Inc. T_
IMPORTANT:
1 represerR that 10 the best of my b owledge,the deceased(has) peoemelrar,del b Mator or any other battrirY operated
device in his or her body. (Circe One)
I cenffy that I have full power and et0wrtratbn W arrange for the cremation of the remelns and to direct the dlspoaiHon of the
cremated remains,then any povanal pos9esskwo hence either been ren ved or may be destroyed,and apse to protect,defend and
save harmless Pk*View Cremetw1um*am any and all dakne and den wWs for toss or demapas vrNdt may be made apainat them
by reaser�of or conrected wkh the c enalon of said remains as directed,whether such daims or demands are or are not wholly
Use or freUr�--A
Carleton Funeral Home, Inc.
/(yyp�) (Address)
l (Sipnature and Address of Relative or Lapel Repreaerlcawe)
1
Sipned on this date: 11,r rt t L
Disposition of Cremated Remains
I hereby direct Pkm View Crernmdum to dispose of fhe cremated remains as RdMS:
Mail to
other emanpements-Pests spw0y:
if pAver¢ation of cremated remains is requested,check here XX
Revision:January 1,2006