Ristau, William l O O
F QUEE9�(,50UrVIEWE VIE .`J
CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12844
(518) 745-4476 (518) 745*-4477
Funeral Director
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Date Of Cremation � _
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Time Cremation CompIe ed 3
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Tom of Queensbury
Pine View Cemetery and Cremakidum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477 '
Authorization to Cremate
The undersigned requests and autltortaes Pk*View Crematorium,In a0cordance wkh and subject to ks Rubs and ReMdatkm to
cremate the remains of:
William Francis Ristau M
(Name) (Sex)
20 Circular Drive Hudson Falls NY 12839-
(SUVO) (CRY) (SWO) (Zip Cam)
vvlto died on 18 t h day d April 20 O 8
at 20 Circular Drive Hudson Falls NY
(Place) (Address)
Name and address of a- so livi V nalaf;0 or natim of person+aut Wdzk p cmmetiort:
LaMountain Megan 375 Bay Rd. , Suite 200, Queensbury, NY 12804
(Name) ( )
Relationship 1
0 the deceased Friend
Name of Funeral Kno Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my luxNAedge,the deceased(ttas (has no) ,defibr ator,battery,�y per,power
cK radloac he hnlpiient or radloactive device kt hie or her body.
I certify that I have RA power and authorization to orange for the cremation of the ran aft and to direct the disposition of the
cremated remains,that any personal possessforts have aN a been removed or may be destroyed,and agree to protect,defend and
save itertttbaa Pine from arty artd al dsirns and derrtartds for ben or rim sges whicdt may be made egaksR own
by rown of or
conne
or wkh tftt:aematim of acid remains as directed,whadw such rlwd s or de antis are or are not wholly
68 Main Street, Hudson Falls, NY
(Address)
375 Bay Rd. , Suite 200, Queensbury, NY 12804
(Signature Address of or Representative))
Signed on this date: D
Disposlim of Cremated Remains
I hereby Bred Pine View Crematorium to dispose of the crameted remains as follows:.
Mail to
Other arrangements-Please apedfy:
If pulverization of cremated remains is requested,dick here XX
P*vWm:April 18,2007