Duell, Gertrude 1
P,e Virly
mOF QUEENSBURY
ru Ceetery and Crruratoriuu,
21 Quaker Road, Q,rtr„sht,ry, NY. 72804.5902
(S 18) 745.4476
hirP:/�""^v�vqueensbu (S18) 745.4477
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Funeral Director.
Name of Deceased:
Case Number.
Date of Cremation:
Retort: 7tc
Time Cremation Started:
'rime Cremation Completed: {o�
TYPe of Container.
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Remarks:
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" Ho ,,, r of Natural BrautY ,,. A Gno ,f Place to Live
Town of Queertsbury
Pine View Cemetery and Cremaknium
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 Cremefodum,In aocordence with and subied to Its Rules and Regulations to
cremate the remains of:
Mrs. Gertrude Eleanor
(Name) (Sex)
The Orchard Granville NY 12832-
(SUBM) (City) (State) (Zip Coda)
yyt died on dayd 06/05/2008 20_
at Glens Falls Hospital Glens Falls NY
( ) ( )
Name and address of na- m It living reletrves or name of person authortzInrg cremation:
Mr. Paul Hunsperger 5202 State Route 149
(Name) (Address)
Rekftnship to the deCaared Brother
Name of Funeral Inkne Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my lahorvledge,the deceased(thee) SnO lakes,deftUalar,battery,battery peck,power
cell,redlosctive implant or radkWKIWe device in his or her body.{
1 oertify Ong I have fill power and authorisation to anarW for the t7ern81100 of the remains and to direct the dispoeitlon of the
cremated tameins,that any personal posseesk ns have either Dann removed or maybe destroyed,and agree to protect,defend and
gave hermiees Plne View Crematorium from any and all daM and dementia fqr lone or demapes W dd may be malls ageirtst them
by reown of or caxteded wkh the croma*m of said remains as dkocled,whether such Clain or derrhentd8 are Or ere not wholly
groundless, fiaudL4enL
68 Main Street, Hudson Falls, NY
( ) (Address)
5202 State
(Signa►uo eq Addrifts of Relative or Legal Representative)
Signed on this date:
Diepoeltion of CremMed Remain e
I thereby direct Pine View CremeWiton to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please spedfy:
If ptAwization of Cremated remains m requested,check here XX
Revision:April 18,2007