Ehatt, Barbara '7"nrkTN OF QUEE9�50urF�
PINE VIER' CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745.4476 (518) 745-4477
Funeral Director
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Town 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 authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Barbara Ehatt F
(Name) (Sex)
12 Hartford Ave. Apt A Glens Falls NY 12801
(Street) (City) (State) (Zip Code)
who died on 5th day of January 2007
at Glens Falls Hospital ECG 100 Park St Glens Falls. NY
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Peter Ehatt (Son)
(Name) (Address)
Relationship to the deceased ynn
Name of Funeral Home Re-gan and Denny Funeral Star-ViGe
IMPORTANT:
I represent that to the best of my knowledge,the deed(has)or(has no)pacemaker,defibrillator or any other battery operated
device in his or her body. (Circle One)
I certify that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defLnd and
save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made against them
by reason of or connected with the cremation of said remains as directed,whether such claims or demands are or are not wholly
groundless,false or fraudulent.
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(Wdn ) (Address)
(Spiature and Address of Relative or Legal Representative)
Signed on this date: JOC).I
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Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Pleasespecify: Return tc�F„no aj� HOrlt�
If pulverization of cremated remains is requested,check here X
Revision:January 1,2006