Carranza, Rachel rl"-IrNIN OF QUEEN,5BUr�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
/� Funeral Director 4, .M
Name_ �( Ctir�� nze, 3S�
Case#
Date Of Cremation Av [At 12 k
Time Cremation Started -' 70
Time Cremation Completed J=3u
Type of Container ar
ra
Remarks
ffTLI/ oOn
DJ �2=Zo
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Town of Qumsbury
Pine View CemrleWy and CYemakmtum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Ofte: (518)745-4476, Crematorium: (518)745-4477 '
Authorization to Cremate
The undweigned requests and&*mrtzm Pine View Cremab rium,In Saw0ence wkh and U#ed to its Rubs and Regulations to
cmrtate the remi*o of:
Rachel E Carranza F
(Name) (Sex)
Lot 1, Broad Hudson Falls NY 12839-
(Str W) (City) (SWO) (Zip Cam)
who died on day of 08/16/2007 20_
at EDEN PARK HEALTH CARE Glens Falls NY
(mi) ( )
Name and address of nearest IivMp nflat"or name of parson autetat V aematlon:
Valentina Eastman 44 Briarhurst Drive,,�arrs�JcX7-=�
(Name) (Address)
Rdiatlarohip to the deceased Daughter
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
i represent that to tha beet of my kowwbdge,tha deoeaeed(tteis) (hse no) ,deft4lator,battery,be lWy pack,power
veil
,radbective implam or radbacMm dovtos In his or her body.
1 ow*titan I tars full power and authorization to awanga for the ctiernatlon of the remshs and to*ad the dispoeltlon of the
cranuatsd rarruaMrs,Urat arty pereoud poseaeeionta have akltar been ratnoved or maybe deaboyed,and agree to pi defend and
earn hw *m PMre View Crematorium from any and ail dairtrs and demands U bee or demapse which maybe made agoot them
by reason of or connected wkh ft aamation of add nen akts as 0ftled,whether such dairtts or daaiards are or are riot wholly
tabs«lk au
68 Main Street, Hudson Falls, NY
44 Briarhurst GanSz vC2��Tj Y
(SVuft a and Address of Reft0m or Legal Representetive)
Signed on this date: Q�/ ��i a 00 7
Disposition of Cremated Ramiro
I hereby direct Pine View Crematorium to dispose of the cremated remake ea foNowe:.
Mail to
Other arrbngernaft-Please specify:
If pk>>verbot of cremated remains is requested,dredc here XX
Revisiorc April 18,2007