Haskins, Philip TOWN OF Q UEENS B UR Y
Pine View Cemetery and Crematorium
27 Qunker Rond, Queenshury, NY. 72804-5902
(518) 745.4476 (518) 745.4477
h((P://wxv\v.queensbury.net
Funeral Director: C, t,�
Name of Deceased: �� f
Case Number:
Date of Cremation:
Retort: C:
Time Cremation Started: 7 : L10 M
Time Cremation Completed: 1 c '. o v
Type of Container:
Remarks:
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" Howe of Natural Beauty ... A Goof Place to Live " j
' #Z0
Tom of Qwwrisbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, CremaWrium: (518)745 4477 '
Audxmizadon to Cremate
The urtdersigned reWasis and aultweass Pine View Crematorium,In accordancewkh anti**W to ks Rubs and Regulations to
cremate the rernaine of:
Philip Hanley Haskins M
(Name) (S")
38 Notre Dame St. Hudson Falls NY 12839
( ) (Carr) (State) (ZJp Code)
YAw died on 2 8 t h day d April 20 0 8
at Albany NY
( ) ( )
Name and address of nearest living rttkbo or name of person suMorb*V aernabon:
Elizabeth Marshall 11 McKee Road, Minerva, NY 12851
(Name) (mew)
Reiatiprlglliit to the daGdrssed Daughter
Norm d Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
l represent that to the best of my tawwledge,the dweaw d(tms) rto) after,cid briAator,battery,battery peck,power
call,redioac.ow implant or n0oac Ow device in his or her body.
I oeatily that 11 fud power and mAwrfmNon to arrange for the cremad4n or on remains end to dWW the disposition of the
cramat>wd remains,that any peraortal poeseesiorts have eNo been removed or maybe destroyed,and agree to protect,defend and
save ha ntlesa Pine Vlaw Crematorium from any and al tlsirrts and demands for I=or damages whidt may be made ago*them
by or carxtected wilt thean atatiort of odd rentefrta as dir�oCtecR,rrlteflter atilt dairtts a derrtertds a3re or are rat wlwMy
or
C 68 Main Street, Hudson Falls, NY
(Wltnass) (Acicitess}
11 McKee Road, Minerva, NY 12851
and Address of Relative or Legal Representative)
Signed on this date: il
Dispostion of Cremated Remains
I hereby direct Pine View Cmmatorium to dispose of the cremated remains as Wows-
Mail to
Other arrargemecis-Please spew.
tf pulverization of cremated remains is requealed,dmdk here xX
Rewlsiarr April 18,2007