Winne, Lisa P CN E Y(E W � r� `-'�
CEMETERY ,,ND CREMATORIUM
RO',D, QUr"NSBURY, KL'W YOR}C IZ804
(518) 745.4476 (518) 745',4477
Funeral Director
Casey
a ' e 07 Cremation
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" e Cremation Started �p
^� Cremation Completed O �w
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery O(flow (518)745-4476, Crematorium: (518)745.4477
Authorization to Cremate
The trnftVigrred requests and eu#wetea Pkwe View Cremdarlunh,In a000rdance with and su*d to ks Rubs and Regulations to
cremate the remake of:
Lisa Winne F
(Name) ,/ { )
Mountain ltLO, Moreau NY
mo.ie-a
(street) (City) (SUM) (ZJP Code)
who died on dayd 06/23/2007 20_
at 88 Warren Street Glens Falls NY
(Plata) (Address)
Nerve and address d on as living relative or name of pereon suMorb ft cremation:
Roberta Lee-Brynes 14 Haviland Ave.
(Name) (Address)
Relationship to the degeMW Mother
Named Funeral Home Carleton Funeral Home, Inc.
IMPORTANT: j
I represent Out to the best of my knowledpa,the deceased(tree)or on no)pecomalm,defibriNetor,be",bafty per,power
call,radloecdve ietple m or radioactive device in his or her body.(Ckde One)
I oar*Chet I#rave fill power and atawfteton to wmngo for the caaematlon of tre remalre end to direct the diepoeelon of the
cremated remains,that any personal posssesbne he"altfher been removed or may be desIrvied,and agree to proled,defend and
save harnihm Pbo View CremelnrUn from ttrhy and aN tlairn a and demands for loos ar demapes whIch may be made against!item
by reason dcat mcwd wkh dw cramodan of said nwwkns as dkeOsd,whether such daptts or demends are or are not wholy
68 Main Street, Hudson Falls, NY
14 Haviland
pw and Address of Welative or %-W�R7epresersetIve)
Signed on this date:
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Dlepositm of Cremated Remekts
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I hereby direct Pine View Crematorium to dispose of the cremated remake as Wows,
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Mail to
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Other arrangements-Please specify:
If pulveraation of Cremated remains is requested,dm&here XX
Revision:April 18,2007 j