Hobbs, Glenn Yr
QU E E 8U�
PLNE nEW CEMETERY AND CREMATORIUM
QU&Y-FR ROAD, QUEP.NSBURY, K'EW YORK 12804
(518) 745.4476 (518) 745 4g77
Funeral Director
Casey
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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 audtortnes Pie View Crematorlum,In accordance with end subject to ks Rubs and Regulations to
Cremate the remake of:
Glenn G. Hobbs M
(Nerve) (Sex)
Indian River Reha2iiabtt�n Health NY 12832
(Street) (CRY) (Slate) (ZJP Code)
who died on day of 06/21/2007 20_
at Glens Falls Hospital Glens Falls NY
(Plam) ( )
Name and address of rhaereet living reW&m or name of person eutttortzing cremation:
Terry Hobbs 16 Spring Street, Glens Falls,NY
(Name) (Address)
Retatiorrship t0 the deceased S o n
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge,the deceesad(hn)or Cm nD)pecemakier,datlbfttor,may,baftY per,power
cell,radioecdva WnpW t or ra*oective device In his or her body.(Chile One)
I ovWy that I here M power and sutlwrke<lon to arrange for the crenxWom of the remains and to direct the disposition of the
cremated ramains,that any personal poseaesknu have ehhar beam removed or may be desi oyed,and agree to pnAw;,defend and
save harm wa Pine View CremeRorktm from any and all claims and demands for ion or dernages which may be irnarle against diem
by reason of or connected wNh the aemaden of add remains as directed,wheder such rIrA s ar dememds are or are not wholly
false or
68 Main Street, Hudson Falls, NY
O
�6 Spring Street, Glens Falls, NY
(Signature and Address of Reletwe or Legal Representa lve)
Signed on this date: June 22, 2007
Disposition of Cremated Remains
I hereby d rW Pine View Crematorium to dispose of the cremated remains ea follows:.
Mail to
Other arrargemenis-Please spedfy:
if puhmr¢etion of Cremated remains is mWasted,dw ck here XX
Revision:April 18,2007