Kelleher, Sharon TOWN OF Q UEENSB UR Pine Viet" Ctutelery and Crematorium Y
11 Quaker Road, .5902 Queenshury, NY. 12804
(518) 745.4476
hIrP:1A"^'^v.queensbury.net (518)745.4477
Funeral Director.
QPIz .,
Name of Deceased:
Case Number.
�1
Date of Cremation:
10 ZUUe
Retort: ct c N
5
Time Cremation Started: lZ:i16
Time Cremation Completed: , uo Pi'1
TYPe of Container.
Remarks:
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HOi"1e of Nn tit ral Benul
y ••• A Cool Place to Liur "
Town of Qummbury
Pure View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12844
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and authorizes Pbhe View Crane&rlum,In eocordence with encl su*d to Its Rums and Regumtions to
crarrme the retttains of:
Sharon Alice Kelleher F
(Name) (Sex)
7.295 State Route Hertford NY 12838-
(Shem) (C*Y) Own) (7JP Code)
who died on day of 06/06/2008 20_
at Glens Falls Hospital Glens Falls NY
(Ph") (Address)
Name and address of nearest IMM r+eletive or name of person audwteing cremation:
Margaret Howard 34 Vaughn Road
(Name) (Address)
Reiatiorshtp to the deceased Daughter
Name OfFLWerelHome Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the boat of my knowledge,the deceased(tree)or pecerrreker,ddibrilletor,battery,battery pads,power
t ceN,radioactive kyq*w or ra�oective device In his or her body.(C )
t oertify that I have Tull power and auftwb adon to arrange for the eaenatim of an remains and to direct the dmpodtlan of the
cremated remains,that any personal poseessiotm have dthar been removed or maybe deatreryad,and agree top defend and
save harmless Pbha View Crw*arbjm Tram any and ON claims and demands for loss or damages which may be fade agoid them
by remon of or corhnacIed wNh ft cremation of add rmnabm es directed,Wedtar such dab,ts or demands are or are not wholy
Rullfalse or Tiaud lertt.
68 Main Street, Hudson Falls, NY
(W ) (Address)
34 Vaughn Road , Hudson Falls, NY 12839
(SI&fitufe and Address of Relative or tegai Representative)
Signed on this dace: -June 8, 9'O V U
Disposition of Crefeted Remains
I hereby direct Pine View Crematorium to dispose of the crenated remahs ea follows:.
Mail to
Other arrangements-Please spedry:
tf pulverization of cremated remains is requested,check here XX
t*vWDrr.April 18,2007