Doyle, Marion 1. 1
.I
p rOirt►'y1V OF QUEENSBUR Y
Cemetery and Crearaloriunr
11 Qrrnkrr Road, Queenshury, NY. 12804.5902
(518) 745.4476
I'IP:"�+%v.queensbu (518)743.4477
ry.net
Funeral Director:
Ld(.)
Name of Deceased:
Case Number. Z
Date of Cremation: v�
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Retort:
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Time Cremation Started:
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Time Cremation Completed: 0 , 11 SsS
TYPe of Container. a
Remarks:
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Horn ,, of Nnlnral Benuly ... A Coorl Plnce in r
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Town of Queeris"
Pine View Cemetery and Crematorium
21 Quaker Road,QueensWry, New York, 12804
Cemmtery Qfflf:e: (518)745-4476, Crematorium: (518)745-4477
AudxxizaWn to Cremate
The undersigned requests and authnirtaies Pine View Creavoorlum,In accordance with arW subject to its Rules and Roguletions to
cmmate the remains of:
Mrs. Marion L. Doyle F
(Name) (Seat)
1.8 Grove Ave Hudson Falls NY 12839-
(Street) (City) Owe) (7Jp Code)
who died on 12th daYd June 20 O8
at Residence Hudson Falls NY
( ) (Address)
Name and address of merest living relettve or name of per"authorizing genre*m.
Kathleen French 447 Mott Road, Gansevoort, NY
(Name) (Address)
Reietionship t0 the deceaged Daughter
Name of Funeral Fkxe Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my larvwiadge,the deoessed(Ines)or(tree no)pacemalw,deB Bile r,battery,battery pack,power
cefl,radlaective Implant or nKkwcdm davits in his or her body.(Circle One)
1 oar*that I trove U1 power and eu ha tzenon to arrange for the oremerlion of the remais end to dWW the disposition of the
cremated remains,that any personal poeaesslotvs have abllm,begirt removed or may be destroyed,and agree to pnAwt,defend and
save hat ftw Pine View Cranhetorium from airy end aA r1mi wariddenwkisforkmordsmagesvolid may be nude against there
by resson d or connected wish the cremation of acid remains se directed,whether such daiftts or derrtande are or ere not whoNy
tales ok All r fraudtftl.
68 Main Street, Hudson Falls, NY
rfflness) (Address)
447 Mott Road, Gansevoort, NY
(Signature and Acidness of Retatim or LL%W Represereative)
— -
Signed on this dew. ��1 4or
Dispoettim of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the aemated remains as fbilows:.
Mail to
Other arrangements-Please specify:
If pu%mraation of cremated remains is requested,duadc here XX
FtevWm:April 18,2007