Abrahamson, Richard TOWN OF QUEEN5BUT,
PINE VIEW CEMETERY AND CREMATORIUM .y
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4.477
Funeral Director K, ' r
Name R1C�Ar(� A�r'w+w
•nSy� Case# 53Z
Date Of Cremation
tcem Err 13 2oa
Time Cremation Started 1; /9,
AM
Time Cremation Completed
Type of Container 4� bOwr(/1 15 G 5E
Remarks
Nov 00
R; Zp
COOL jy:ZG �h
5 32
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 authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of:
Richard A. Abrahamson Male
(Nam) (Sex)
214 McDougal Lake Rd. , Cossayuna, NY 12823
(Street) (City) (State) (Zip Code)
who died on 9th day of Dec. 20 07
at Saratoga Hospital
(fie) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Patricia F. Abrahamson, 214 McDougal Lake Rd. Cossayuna, NY 12823
(Name) (Address)
Relationship to the deceased Wife
Name of Funeral Home M_R Ki Imer FimPral Hr)me, 123 Main St. Argyle, -NY
IMPORTANT:
I represent that to the best of my krowiedge,the deceased(has) (has pacemaker,defibrillator,battery,battery pack,power
cell,radioactive implant or radioactive device in his or her body.(Cir )
I certify that I have full power and authortzation to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crematorium from any and ail claims and demands for loss or damages which may be made against them
by reason of or connected with the cremation of said remains as directed,whether such claims or demands are or are not wh)lty
groundless,false or fraudulent.
1 (_Wdnes�s) (Address)
ccaj d
(Signature and Addrbss of Relative or legal Representative)
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify:
If pulverization of cremated remains is requested,check here
Revision:April 18,2007
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