The URL can be used to link to this page

Carter, Mark T074N OF QUEEN5BU9� PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 I� /' Funeral Director��K�Q ,�ame._Cyar1� C. �� Case# 5 Dace Of Cremation Iea t%I.-M, 00 Time Cremation Started • Z 6— Time Cremation Completed J' 36 Type of Container !o � � Remarks S too T:1640 �, D6 CpaL' Y" 31>Ah ------------ I w � 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 acNrortzes pine View Crematorium,In accordance with and subject to its Rules and Regulations to cremate the mains of uIf (Sex) (Name) (� /2- �/',— (fit) (City) (State) (ZiprWe�)7 who died on i 1 ` day of Q Lti 20©/ l c ( ) (Address) N7ame 7a !:ress of nearest ' ' relative or name of person autfrorizing -..! Jy .J �fLt✓rit%s (Name) (Address) Relationship to the deceased �( r Name of Funeral Home IMPORTANT: the deceased(has) (lies no=1p •daiibrillator,battery,battery pad(.POW" 1 represent that to the best of MY Wmiedge, cell,radioactive implant or radioactive device in his or her body.(C 1 certify that I have fiu0 power and NaWt zat n to arrange for the Cremretion of the remains and to direct the of the have either been removed or may be destroyed.and agree to Protect,defend and cremated remains,tl Y� �al dairns and demands for loss or damages t my be made agair�err save hamdess with the lumcre ft on of said reaeains as diected,v&,W r such dalms or demands are or are not whoDY by reason of gmundless, J (Address) Afy rtrress) (Signature and Address of tive Legal Representative) Signed on this date: Disposition of Cremated Remains I hereby direct Pine View Crematorium to dispose of the cremated remains 88 MOW : : Mail to Other arrangements'Please WeW If pulverization of cremated remains is requested,c he&here Revision:April 18,2W7