Howard, Ila V.
�O O
PWE QU
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V'E�' CEMETERY AND CR
QUAKER ROAD, QUEENSSURY EMATORIU
(S18) 745,q.476 ' NEW YORK 12804
(518) 745.4477
Funeral Director
,Name Il �
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I.JCj _
Case#.
Da e Of Cremation LI_ � _ () b
Time
Cremation Started
Time
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Cremation Complete ZU
Type of Container
Remarks 2 C
CC)L---------------
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476,Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,in accordance with and subject to its Rules and Regulations to
cremate the remains of,
-:rl0. 1110L -u,-LA F-.—alc
(Name) ` (Sex)a� 14j)CYCA 0UecniWrjj NY.
(Street) (City) (State) (Zio Code)
who died on day of_�2'd Q C1 20 S
at 1e Y1_-S S 14, -
(place) ( ress)
Name and address of nearest living relative or name of person authoring cremation:
S �Cb)ie22 J2?2U Cif_
(Name) I (Address) „
Relationship to the deceased V3"
Name of Funeral Home 5-
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or ,no) aker,defibrillator,battery,battery pack,power
cell,radioactive implant or radioactive device In his or her body.(CI
I certify that I have full power and authorization to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made'against them
by reason of or connected with the cremation of said remains as directed,whether such claims or demands are or are not wholly
groundless,fal or fra ulent.
/ (Witness (Address)
( nature and Address of Relative or Legal Representative)-
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify:
If pulvertmtion of cremated remains is requested,check here
Revision:April 18,2007
NEW YORK STATE DEPARTMENT OF HEALTH
Vital Records Section Burial - Transit Permit
Name First Middle Last Sex
Ila M, Howard female
Date of Death Age If Veteran of U.S. Armed Forces,
03/31/2008 86 War or Dates n/a
Place of Death Hospital, Institution or
City, 7&WI6RX NW, Glens Falls Street Address Glens Falls Hospital
A. Manner of Death®Natural Cause Accident Homicide ❑Suicide Undetermined D Pending
Circumstances Investigation
Medical Certifier Name Title
Timothy E. Murphy, COroner
Address
52 Haviland Avenue, Glnes Falls ' NY 12801
Death Certificate Filed District Number Register umber
City, kKHXDIIKWX Glens Falls 5601
(]Burial Date Cemetery or Crematory
04/04/2008 Pine VIew Cremator
[]Entombment
Address
'`.®Cremation Queensbury, NY
Date Place Removed
Removal and/or Held
and/or
Address
Hold
{Z Date Point of
..R Transportation Shipment
0 by Common Destination
Carrier
Q Disinterment Date Cemetery Address
[�Renterment Date Cemetery Address
Permit Issued to Registration Number
Name of Funeral Home singleton—Healy Funeral home 01641
Address
407 Bay Road, Queensbury, NY 12804
Name of Funeral Firm Making Disposition or to Whom
Remains are Shipped, If Other than Above
Address
ul
tIk
fl' Permission is hereby granted to dispose of the human remains described bove as' ica
Date Issued 0�/Q3 (� Registrar of Vital Statistics t
(signature)
District Number ,5760/ Place
I certify that the remains of the decedent identified above were disposed of in accordance with this permit on:
tu Date of Disposition �/�}� Place of Disposition P)j;{,,j
(address)
0211.
41
(section) (lot number) (grave number)
QName of Sexton or FJ rson in Ch ge of Premises ' e n N
/ (please print)
Signature Title hwlet' ,-
(over)
DOH-1555 (02/2004)