Benoit, Mary OFQUEE9�5(BU,��
PINE VIEW CEMETERY AND CREMATORIUM
QUAKFIR ROAD, Q�jEENSBURY y�, YORK 12844
(518) 745 4476 (518) 745-4-477
Funeral Director c r.TO A/
.Fame OIT I~
Cased G L/
Date OF Cremation
Tame Cremation Started —q _
Tame C ema t : Al
on Completed
Container IS?' C9 SL
Remarks /
i �1 � 35A
07
Town of Queensbtiry
Pine View Cemetery and Crematorium
21 Quaker Road,Queentabury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and euVxxtms P4te View Cr mvdadum,In aawrdence with and subject to Its Rules and Regulations to
c nvme the rerneirts d:
Mary Ann Benoit F
(Name) (Sex)
4.3 Belle Queensbury NY 12804-
(81reet) (City) (SUM) (21p Code)
w to died on day d 0 2/01/2 0 0 8 20_
at Glens Falls Hospital Glens Falls NY
(Place) ( )
Name and address d rtearast Itving rrtlathra or name of person aWhorb*V aernWan:
Mrs. Laurie Smith 43 Belle Avenue , ,,VU,, ,,j.Lw y
(Name) (Address)
RelaeonM to the deed Daughter
Norm d Funwal Hww Carleton Funeral Home, Inc.
IMPORTANT:
I repeeartt tug to the best of my knowkKV%ttta deceased(has) tea nc) nteker,de�ibri 101w,battery,battery tom.poww
ca,redbec d"implant or mftecdw device In his or her body.
I oer*that I have fuN power and ar dwdzstion to arrange for the c renwAlw of the renw is and to di W the disposelan of the
cremated ramaine,that any pemwel pew have ebtar been removed or may be destroyed,and agree to protect.defend and
save harftw Pine View CremeloNum from any end aN dairrrs and detnte Ws for bee ar damages which may be made apttirt A dom
by reeeon of or connac ed wkh On cz mwdon of acid rentairw as dlreded,vntrellter wch do' a or da is are or arse not wholy
groundless,fate or fraudulent.
m ,N n ^ Q 68 Main Street, Hudson Falls, NY
(J /�(yy (Adtess)
43 Belle Av'. ) (-�u�.
J '/-�M IMU4Z
(Signature o6d Address of Relative or Leo Representative)
Signed on this date: .L �3 t7 cJ t3
Dieposkim of Cremated Remaine
I hereby direct mine View Crematodum to d1lSpose of the crertmW remains as follows:.
Mail to
Other arrergernwft-Please specry:
tf pulveraetion of w mated rvmeins is mWested,check here XX
Revisiw.April 18,2007