Repo, Mary TO W�/ OF
QUEE9 �(BUTO
WE VIEW CEMETERY AND
p
QUAKER ROAD CREMATORIUM
QUEENSBURy, NEW YORK 12804
(518) 745-4476 (518) 745 4477
Funeral Director
Name M4f
C a s e# 30
Date Of Cremation
1 �
Time Cremation Started
Time Cremation Completed
3' Z6
Type of Container 01
Remarks
IO 1:
3,0 H
(ac 3 ZC)
TOWM of Queendwry
Pine Vlew C.emeWy and Cremstatium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Audwizabon to Cremate
The undersigned retpesls and autl orlaes Pk*Vtew Coematorlurrt•In amordertoe vylth end sul ow to ks Flubs and dons to
CMnate the femeUts Ot
Mary Alice (Folger) Repo F
(Name) (S"
10421 Route 40 Granville NY 12832-
{ "91) (City} (Stets) (Mp Code)
vdm died on 20 day of February 2008
at The Orchard Nursing & Rehab Center 10421 Route 40, Granville, NY 12832
( ) (Address)
Name and Kkhm of newt living relet m or Hems of person audmxt lrp cm mgm
Syndonna Anoe 193 Benn Road, Granville, NY 12832
(Name) (Address)
�1O ft detlra9ed Daughter
Nlsmeoff=uneni0kx, Carleton Funeral Home, Inc.
IMPORTANT:
I represent that d the bed of my latawbdg%the deaeow d(has)tx ra) melaer,defbrfletor,buttery,bWay peak,pmw
OK radoeCdve h 14ft ar nKNOSdMs device to hie ar her trody.{
1 OOrWY that I hove 11A power end au&Kwbn*m b anango for the caenwft n*(the rarnatrrs end to dlreet the ftpoeWm of the
save Pine View Crtlultel0rtune s hens eM a been reetoved or may be desttayed,erd arse to prated•defend and
any rind all tdn' m and denwids far bee ar dsmapes whldr maybe made egawt them
by wtih the of said reatatns es dnected,rrlr dwo suds r-alms ar demertde are or ere not Wwjy
*MxkAom
68 Main Street, Hudson Falls, NY
(Addr+eas}
�l e Road, Granville, NY 12832
and Address of Rebel w or Leo Pkpveenke")
Signed an Utb date:
Dleposllion of Cremated ttmekts
i hereby dred Pkte View CtemeAoriam to detpose of the cremated n m kw as W ws:
Mall to
Other anartpww is-Please spew-
8 mimb etian of cremated+e ok is mWe ded,dmck here XX
Revis=ApA 18,2007