Truesdale, Tina (zu rz B
P[NE SEW CEMET>~Ry ^�U CREMATORIUM
Qti}CP�t ROAD, Q(jeE.NSB Y
(518) 745•4476 �W YORK 128o4
(518) 745'.4.477
eral Directoc
(nt !/ �"
�f uP T
sc le(
Casey ayb
a ' e of Crematyon
Uo�
. T.e Cremation Sca - ced
UO
^� Ctematton Completed �►
;e of Container C(o+ � � /�
lri3� (. c
� : � a �
. t
• a2°tv
Town of Queens"
Pine View Cemeldary and Cremakftm
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requmu and authortaas Pine View Crematorium,in aoowdence wkh and subject to Its Rules and Regulations to
cremate the nemebrs of:
Tina Lynn Truesdale F
(Name) (Sax)
Homeless NY
(Sh") (City) (State) (Ap Cade)
v*fo died on day of 0 7/0 8/2 0 0 7 20_
at Big D Mobile Home Park, Rock City Falls NY
(PIWO) ( )
Nerne and address of rrueraet living raiet w or name of person aurborfr kv crernalkm:
Paul E. Truesdale 49 Hatchery Road
(Name) (Address)
RekMorrstrip to the deceased Fat h e r
Namec(FuneralHome Carleton Funeral Home, Inc.
IMPORTANT:
I rspa"It ttrd to the bed of my taawledge,the deoaesed(has)or 0M fw)pacenidw,deftdkW,battery,betwy pedt,power
tea,radoaCtive implant or raTKoactim device in his or her body.(Ck%Ae One)
10W*that I have fill power and auttw izatlon to arrange for the cnimm Din of the remelt and to direct the diepoealon of the
uematsd remains,that any personal pew have aN a been removed or may be destroyed,and agree to protect,defend and
save hwnWs Plne View Crar owrWm from any and al tisirns and demands for bee or dwmps which maybe made egebtst them
rPmmewn ; the cremation of said remains es diWed,whether such debits ar demands are or are nat wIvoy
68 Main Street, Hudson Falls, NY
Hatccheerry ev&,I CA.,v S5efJ f��
(Signature and Address of Relative or Legal Rep osenWive)
Signed on this date: 1 10-1
DispoekW of Cremated Remains
1 hereby direct Pine View Crenm*wium to dispose of the c meted remains as tiollowa:.
Mail to
Other arnoVern"-Please spedfy:
tf pulver¢ation of Cremated remains is rued,dreck here XX
Revision..April 18,2007