LaMotte, Ruby Yr
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PINE VIES' CEMETERY AND CREMATORIUM
QU&KFR ROAD, Q(JEENSBURY, NEW YORK 17804
(518) 745.4476 (518) 745'•4477
Q 1 Funeral Director—
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:a � e Of Cremation
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^ e Cremation Started
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Te Cremation Completed i
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Pe of Container (�.� ( �
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�emarks
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Town of Queerm"
Pine View Cemetery and Crematotturn
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Cromtorium: (518)7454477 '
Audmia don to Cremate
The t ndWjtylned raquesle and arrtlrortaas Plke View Oremaforiunt,In aocordo i r 0 with 04 subject to b Rubs and Regwokw a to
cremate the remekre of
Ruby (McEntee) LaMotte F
(Name) /► (Sex)
5.48 Lower s� Hudson Falls NY 12839-
(Suva) 0y) (SI0 ) (7J p Code)
yWiodWon day off 05/15/2007 20_
at Residence Hudson Falls NY
(PISM) ( )
Pam is and eddrees d In no IMM rrilettve or name of peraw auttrort ft cremaTton: _
Cheryl Ireland 548 Lower Allen Street
(Name) (Address)
ReletiorW*t0 the deceased Daughter
NamedFurmalt1m. Carleton Funeral Home, Inc.
IMPORTANT:
i represent that to lira beet of my bvNAodp,the doomed(hm)or(m fw)p 3ewnd er,deii6 Noma ,battery,be tlery pack,power
oK radioecave krrptent or nxNaecive dewae In hte or her body.(Ckde One)
I oerWy that i trove U power and audwrtmtlon to ammW for the cremagpn of the remalrre end to dkeot the diepoW rr of the
cremated remakes,that wW pareorrd poeseeebrte have aNhar been removed or may be deakayed,and agree to proisGt,defend and
sews harrrMeea Pine Vbw AertrsfOrMine from arty and aN dams and demands for lase ar damages which maybe made agi l gi!teem
by reem of or conneaed wNh tM aeme0on d add remake as dbuied,whet w aucfi del 'a or fie rrrarrds are or are not wholy
grouindkos,tabs or*mxk lent.
68 Main Street, Hudson Falls, NY
548 Lower } l
errd a ) S
signed on this date:
Dbpoabon of cremated Remakte
I hereby dked Pkv View Crenmlork n to dbpoae of fhe c nwa tad rernakre as Wows:
Maii to
odrer arrenpernerm-Please spew.
If piny amnion of cremated remains is rued,dradc here XX
Re MkvL April 13,2007