Miner, Bailey OF QUEE�(Bur
�
PINE VIEW CEMETERY AND CREMATORIUM
QUAYF—R ROAD, QUEENSBLRY NEW YORK 12844
(518) 745-4476 (518) 745'-4:77
M . Funeral Director
Name Gi Ou I ll(t!�
.. Case # (,7
Date 0 ; Cremati.on
rime Cremation Started 7!� S
T . me Cremation Completed
'Ype c : Container — —
`'• o�< eo wclr 4 cJ� C
Remar'Ks
�� �ti T z s
Town of Queensbury
Pine View Cee(ery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned regnests and aLim n Ixes Ptne view Cremtaft*jm,in amordenm wth and subject to is Rules and Regubtlons to
oemue the remains of:
Bailey Lynn Greene F
(Name) (Sex)
1.53 Lamplighter Acres Fort Edward NY 12828-
(street) (CRY) (state) (zlp Code)
who died on day of 02/02/2008 20_
at Glens Falls Hospital Glens Falls NY
(Place) (Address)
Name and address of naarast living relariva or name of person autltodzing aerned=
Ashley Miner 153 Lamplighter Acres, Fort Edward,NY
(Name) (Address)
Reietlonship to the deCeOW
Mother
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I reyreeunt did to the best of my knowledge,the deoeaeed(hes)or(hors no)pacemaker,deiibrillemr,battery,battery fecK pMWW
cK radfoecdve intpta+tR or nK*x *m device M his or her body.(Ckde One)
1 cw*dnart I E wv full power and audwrizetlon to arrange for the ovwnadon of the remains and to dWW the dispoel lan of the
cranv*W ronm*rs,that any personal poeseedora have 6111 a bean removed or may be destroyed,and agree to p mlect.defend and
save Pine 11bwmium from any and all damms and demands for bee or damages whkdt maybe made against lharn
by or tierttetion d said rotrieins as directed,whether salt dams or demands are or ark not wholly
68 Main Street, Hudson Falls, NY
(Winess) 1 (153 La mmpplighterrAZgvreos, Fort Edward, NY
( of Relative or Legal Representative)
Signed on this date:
Disposition of CrernMad Remakte
l hereby direct Pkte Vlew Crematorkmt to dispose of the cr wmW remains ea 1bNovra:.
Mail to
Other arrengerneng-Please apadry:
If pulvemodon of Cremated remains is mq msW,do*here XX
Ftevislan.April 18,2007