Martin, Pearl �O`WN OF QUEE BU_r�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
�J Funeral Director ��Z
Name t �at� �af��h -�
Case#
Date Of Cremation 7
Time Cremation Started
Time Cremation Completed )b
Type of Container Gti�c Ti-- 157-
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Remarks
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery OR= (518)745-4476, Crematorium: (518)745-4477 '
AuttwriZaBon to Cremate
The andWS%F ed requests and a tow orixem Pkw View Cremerodum,in aacordenoe with and subject to ks Rides and Regulations to
cmme the remains or
Pearl Elizabeth Martin F
(Name) (Swo
West Mount Infirmary Queensbury NY 12804-
(Street) (CRY) (She") (Zip Code)
wAo dad on day 09/13/2007 20_
at Glens Falls Hospital Glens Falls NY
(Plata) (Address)
Name and address d rtam me UvbV n**ve or of persati authorb*V cm-ni on:
Jul ►Mu c--S 4� yqY
(Narne) ( )
Rdiat unship t0 uta decaaeed "U"Y ��
Named Funeral ilonte Carleton Funeral Home, Inc.
IMPORTANT:
l repreew lief to tlta beet d my iawwledpe,wa deossaed(haw)or(has no)per,deftill Aor,bawy,balmy per,power
cK nullosclive li np o or nK*wcdw daubs In his or her body.(Ckrae One)
I osri ft that i hate U power and suftwb atlon to arrange tar ttte creawkin of we remakes end to dlretR five dlspoattlon of we
cremated rwolns,that arty personal possessions have alliar bean removed or maybe deeeoyed,and agiee to proler. defend and
save hannlaas Pine View CrwOorksm room any and all del ma and demands for loss or damaps which may be mods apaktdt wam
by meson d or connected with the ownsdon d said remakha as dre04 wholhor such daims or darrlaesda are or are riot whoNy
� elfalse *audttlenl.
Jy' 68 Main Street, Hudson Falls, NY
(witness) (AdfA we
(Sipnatue and Address of Resat W or Leo
RepresaraetMe
Signed on this date: I 107
Dispoallion of Crerneled Remains
I hereby awt Pine View Cremetoriurn to dispose of the cremated rernsh ss follows-
Mai to
Other arranIpwnem-Pinson speW.
of ptaverbmdon of cremesed remakes is mgfatstsd,dtedf here XX
Pev►sda r ApFU 18,2007