Hayward, Elizabeth fa
OF QUEE9\�5(Bur
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW YORK 12804
(518) 745-4476 (518) 745.-4-477
r Funeral Director_ LArI@Tb
,Fame �/ t � ��
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Date Of Crema t i.on Z,.-2$ — G�
Time
Cremation Started :UU
I . me Cremation Completed � �5
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Type of Container �-
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Remarks
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Town of Queerisbury
Pine View CemetM and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)7454477 '
Authorization to Cremate
The uidsrsigned requests and a 9mrtms Pine View Crematorium,In accordance with and a#K:t to its Rules and Regulations to
cremate the remekts of:
Elizabeth Tiffany Hayward F
(Name) (Sex)
Kingsbury NY
(Street) (City) Owe) (Zip Cade)
who died on days 02/24/2008 20
at Kingsbury NY
( ) ( )
Warne and address of nearest IMM relernre or name Of person OuthorkCn0 cremation:
Mrs. Madeline Ruth Crispo P.O. Box 756
(Name) (Address)
RekniorisAfp to the deceased Mot h e r
Nam dFuneralthm. Carleton Funeral Home, Inc.
IMPORTANT:
I repreeant that to the bed of my iaawledpe,the deoeaaed(fias) deftriletor.battery,battery Peck.Mower
cell,radioactive or radioactive device in his or her body.( e e)
I oar*that I have U power and authorization to arrange for the cremation of the renv**end to dVW the deposition of the
cremated rarnairts,do any penKml poeeeesiorte have ether bean removed or may be deshoyed,Ord awee to pnaect,defend and
save hat nWa Pine View CrwnoWrbjm from any end all AM -s and demmds for toes or ill apes whidt nvy be made ego 9 A them
by reason of or connected wkh the crartw*m of add ror EW as dYtected,whether such dial w or rin 'aids are or are not what'
-_ L rfr 68 Main Street, Hudson Falls, NY
A0
Z�
Box 756
(Sipnatue end Address OfftW&MfN L"M RepresientetMe)
Signed on this date:
Disposition of CrerMMW Remeine
I hereby direct Pine View Cmmatorkn to diapoae of the c effew remains se*011owa:.
Mail to
Other errangernents-Please specify-
tf pulverization of cremated remains is r+egetesbA,check here XX
Ra f kvL April 18,2007