Farrell, Margaret '7-Or N of QUEENB
Ur�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QLIEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name_ `
Case# �
Date Of Cremation 7601
r
Time Cremation Started -7110 Hn
Time Cremation Completed
Type of Container I(1(clb ar^
raw 4 !SI ('
Remarks
M T b 20 Am
MOVE g: t a AN
4 20 AM
G:3u
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Town of Queensbury
Pine View Cemetery and Cremalaium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Audxxbmdon to Cremate
The undarrrlgnsd requesla and aulhorttes Plne view Cremaiodum,In a000rdence with ano subject to its Rubs and Regubtlor s to
rxamete fire remake of:
Margaret Jane Farrell F
(Nome) (Sax)
6.2 Gates Avenue Fort Edward NY 12828-
(811'eet) 00 (Side) (ZIP rode)
who died on 20th day of September �07
at Glens Falls Hospital Glens Falls NY
(Plem) ( B)
Name and address of Me mg living rels"or name of person*Lewrk&V aemdiort:
Helen Hyatt 58 Gates Avenue Fort Edward, NY
(Name) (Address)
Relatiorrsfrip t0 the deceased
Special Friend
NarnedFrmeralloku. Carleton Funeral Home, Inc.
IMPORTANT:
I repremo that to the beat of+Try kv;wledg%the deceased(hn) (ties no) ,dskdWW,ballery,baklerY Imo,pmef
cap,redfoscam impteru or radioiNAlm device M his or her body.
I ow*that I have fug power and arrlhorbadon do arrange for the aemapon of the remeft end to dlrerx the d epoellon of the
cremated remolne,that any personal possessbrn have eM a,bean rartraved or may be dash e v o ,and agree to pr D I'M depend and
save harntlaaa Plea view CnwwAorkm from any and aN daitrta and dementds for foss or dam ps whls h maybe made agaN st own
by reason d or cornrwcied wkh the asmation d said nemekm es dIrecbd.whether such rim'rr'a or demstds are or are not WvVy
� 68 Main Street, Hudson Falls, NY
(vVWW=) (Addr+ess}
J Gates Ave. , Fort Edward, NY
(Signature Vaud pftew of or t egal Representathre)
Signed on this date: l
Die Mmm of cremew Remake
I hereby dined Me VW%v Crematorhxrr to dispose of Ma cremated remekrs es fopovrs:.
Meal to
other arrengernenis-Please wedfY.
if pulverisation d Cremated mffwkrs is requested,dwdr here XX
Revision:April 18,2W7