Hartung, Charlotte OF 1.1.E B
2 ��s UPr
PINE VIES' CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Fame Gf
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Dace Of Cremation �
Time Cremation Started Iv
Time Cremation Completed :. 30
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Type of Container Id
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Remarks
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57C
Town of Queensbury
Pine View Cemetery and Crematorium
21 Ouaker Road, Queensbury, New York, 12804
Cemetery Office:(518)745-4476,Crematorium:(518)745-4477
Authorization to Cremate
The undersigned requests and auftraes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of
Charlotte R. (Radzuhn) Hartung F
(Name) (SOX)
Fort Hudson Fort Edward NY 12828-
(Street)12/18/2 0 0 6 (city) ( ) (zip )
who died on day al 20 --.
Glens Falls Hospital Glens Falls NY
at
(Pk") (Address)
Name and address of nearest Wing n*KWe or name of person auftrb&V aemnetiorn:
Robert W. Hartung 3126 State Route 4
(Name) (Address)
Rek donnship tat the deceased S o n
Name of Funeral Hoc Carleton Funeral Home, Inc. T_
IMPORTANT:
I represent that to the beat of my Irnowledge,the deoaesed(has)or(has no)Paoamalw,dWbWA for or any olf>Qr battery operated
device in tMs or her body. (Circle One)
I cerliry that I have full power and authorbstion to arrange for the cremation of the remains aid to died the disposition of the
cremated remains,ift t mW povonal posgesslorm have either bean removed or may be destroyed,and agree to protect,delbnd and
save harmless Pare View Cramewrlum from any aryl all claims and demands for loss or demagae wtdch maybe made against ttnennr
by reason of or contented with the awneft of sold remake as diaried,whaerer such calms or demands are or are not wholly
prour ss,false or fraudulent.
�ttx�'a(nd�
of RelatNe or l Repnesent�tive}
SWad on this date:
flsposition of Cremated Remata
I hereby died Pine View Crematorium to dispose of Ure cremated remains as Maws:
Mall to
Other arrangements-Please apathy:
If pulverization of cremated remains Is requesU4 check here XX
Revision:Jertoary 1,2006