Berninger, Catherine �O O
F QUEE9\�5oUr�yPINE VIEW
CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12844
(518) 745-4476 (518) 745.-4477
Funeral Director C"��C��ti
Name ^ fln{ -
�f�'" e� C a s e# (�j3
Dace Of Cremation 3 • �3 ' Og
Time Cremation Started
coo
Time Cremation Completed UO
Type of Container afc 6
Remarks
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as( �� •CEO
Town of Queensbury
Pixie View Cerrw"y and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Ofka: (518)745-4476, Crematorium: (518)745-4477 '
Audxxizedon to Cremate
The w4 signed regneaft and a dweaes Pkte View Crematodurn,In accordance with and a tod to its Rules and Regulations to
dentate the remains of:
Catherine (Reed) Berninger F
(Name) (Sep
2 East LaClaire Street Hudson Falls NY 12839-
(Straet) (City) (Slate) RIP Cam)
who died on loth dayd March 2008
at Glens Falls Hospital Glens Falls NY
( ) (Ad w)
Name and address of 'a- AN Iirbp ntlat W or waste of perean aratnorsdrng cremation:
. � rnti �✓ t✓ ��Ir..,,
(Name) (Address)
Rekdionship to the deceased ✓\/,r c
NarnedFtrterelFionre Carleton Funeral Home, Inc.
IMPORTANT:
l repreeerrt that to the best of+try knowledge,the deceased(firs)or(has no)pacemaker,deibrillow,be",battery peck,Power
cqk radioactive h rq term or radoective In Ire in his or her body.(Cide One)
I oertify that I#rare rim power and euthorbation to anangs,for the aenw0a of On remains and to drect the deposition of the
cranv*W remains,brat any personal possessions have either bow -annoyed or may be destroyed,and agree to proleeL defend and
save hannbo Pkta View Crsmob tjm from wry and ai chinas and demands for km ar dsmapes whtdt maybe made against tftarrt
by reason or or connected wilt the cremation of add rentdrts es d recied.whether such clairtts or demands are or ere not whoiy
`�false or frmrdrlent�
g�x(�/ V ,�,1 68 Main Street, Hudson Falls, NY
l ((� , (Address)
n�i'-sue-s w�d�.s��i 'ZJ '� ��� ...c�!• ' 4� V
(Signature and Address of Rotative or t%W PApreserNathre)
.Signed on this date: c1/L ( I — L cc, .3-
Disposition of Cremated Remains
I hereby dhect Pine Vkw Cmmatorhrn to depose of the aemeted remakts ae follows:.
(d to
Other arvervements-Please apeW.
if puNwtotion of Cremated mmamn requested,crack here XX
Revision:April 18,2007