Pregent, Lester Jr. OF QUEErV5r3UjKyPWE YTE'�y CE
CEMETERY AND CREMATORIUM
QUAY-F-R ROAD, QIjEgNSIjURY, KEW YORK 17804
(518) 745.4476 (518) 745'•4477
Funeral Director j
1
Fame Leyte f
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:ace 0 ( Cremation
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e Cremation Started
Te Cremation Completed -�
?e of Container � A L, A
Is' CSC
Remarks
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Totem 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 undwso-a d requests and authorizes Plne View Cremstorlum,In amordance with and subf ad to Its Rules and Regulations to
c mvwe the remains ok
Lester Pregent M
(Name) (Sect)
430 Lower Main Street Hudson Falls NY 12839-
(Street) (City) (State) (ZIP Code)
who died on day of 05/04/2007 20 7
at Glens Falls Hospital Glens Falls NY
(Place) (Address)
Name and addrasa of rttearast living ralathre or name of person aufltortE tp asm"Un:
Karen Pregent 430 Lower Main Street
(Name) (Address)
Ratetlonift to the deCa998d Wife
Nww of Funwat 1 kx. Carleton Funeral Home, Inc.
IMPORTANT:
I regraweru that to the beat of my kvywkKV%the deoaasad(has)ortiss no eker,deftrilator,battery,battery pack,power
Call,radloacdve ky*ft t or radioactive device In his or her body.(Ctde )
1 ov*that I have full power and au1twdentim to arrange for the c remadon of the remehs and to dkW the disposition of the
crantatad remdna,that arty personal posssesk, he"sinter been removed or maybe destroyed,and agree to protect,defend and
save harmless Pine View Crematorium from wV and al dsirtra and demands for toss ar damages~maybe made agoot dram
by reason of or cunneded vAh tM rrertw0m of add rrenwins as detected,whether aids claims or de do are or are not wholly
�,false
68 Main Street, Hudson Falls, NY
(WIrAM) (Address,)
4 7L
!/ 430 Lover Main Street
(Stgr ewm and Address of We or Legal RepresentatMe)
Signed on this date: -�/7/2d
Disposition al Cremated Remains
1 hereby direct Pine View Crematorkrrn to dispose of the casmated remains as follows:.
Mail to
Other arrangernerds-Please apectljr:
If pulverimtion of cremaW remains is rued,dwick here XX
P*vWm:April 18,2007