Keller, Elfriede � y
TOWN OF Q UEENS B UR Y
Pine View Ceinetery nud Crematorium,
21 Qunker Rond, Queeushurf, NY. 72804-5902
(518) 74 5-44 76 (518) 745-4477
hirP:iiw%-v.queensbury.net
Funeral Director:
Name of Deceased: ( �.tic
or
Case Number: Z U l
Date of Cremation:
Retort: ! 11wA S
Time Cremation Started: ,c;C
Time Cremation Completed: ( ' I S-
Type of Container: �l1 t u�r
Remarks:
" Ho1„ e of NntitrnI Ben itty ... A G0 it Plnce to L , ue '
T
Tom 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 regm is and arrthortees Pine View Crematorium,In accordance with encl su*d to ks Rules and Reguletioos to
aernate the remains of:
Elfriede A. (Pfeffer) Keller F
(Name) (Sex)
10 Lafayette St. Hudson Falls NY 12839-
(suve) (cry) Owe) (7J p Code)
vetodiedon 30th dayd April 2D0g
at 10 Lafayette Street Hudson Falls NY 12839
(Plece) (Address)
Name and address of nrrareet IMM ntlethre or nerve of pam atrtttorizing aema*m:
Martin B. Keller 10 Lafayette St. , Hudson Falls, NY 12839
(Naffw) ( )
Rekn,o,s t0 to
deCeasad Husband
Name of Funeral iiar. Carleton Funeral Home, Inc.
IMPORTANT:
l represent that to the beat of my knowWg%the deceased(has) 5 no) maker,defibrillaW,bMM,bWary tom,power
cell,radloecdve implant or rsdfoacOve device In his or her body.
1 ow*drat I have full power and audwrbmtion to arrange for the cremelion of the ramakts end to direrx the disposttien of the
aerttatftd ramelins,that any Personal possessions have eM om been removed or maybe destroyed,and agree to protect,defend and
save View Crssrretori m from arty end off etairrie and deeterids for bee or dernages whidt may be made egdrot them
by romm aentoUm of said rerrletrs as dkWed,whether such calms a dFxrrartde are or ere vat wholly
Cr 58 Main Street, Hudson Falls, NY
(Address)
0 afayette St. , - Hudson Falls, NY
(Signature and Address of Relative or legal Represerttalve)
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine Vlew CramallMurn to dispose of the aenreted remains es JbIlows-.
Mail to
Oew anvVements- spe
if pAwbadon of Cremated remains is requested,dteck here XX
Revision:April 18,2007