Beecher, Gene � r
i.
1
TOWN OF QUEENSBU•RY
Pine VieW Ce"Ietery and Crentatarinnl
27 Quaker Road, Qneenshnry, NY. 12804.5902
(S 18) 745.4476 (518)745.4477
hi1P:U-1v%v.queensbury.net
Funeral Director:
Name of Deceased:
p -•eckv r
Case Number:
Date of Cremation: �u ('
Zoo g
Retort: -E ��
f,w �'rti 51' C
Time Cremation Started: f d
Time Cremation Completed: it, : T0 I
Type of Container:
Remarks:
$ Ic
it,U;�I^
Am
" Honr o/ Nntnra1 8ennty ... A Good PInc• e to Live •
Town of Queerlsbury
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 requests and authorities Pine View Crematorium,In aacordence with and subject to Its Rules and Reguiatioos to
cremate the remains of:
Gene Edward Beecher M
(Name) (Sex)
258 Main Street Hudson Falls NY 12839-
(811sat) (City) (State) (ZIP Code)
who died on 30 day of May 20 0 8
at Glens Falls Hospital Glens Falls NY
TIMM) (► )
Name are address of nearest lmbV rh;ladve or name of person euthortrtit8 cremation:
Kelli Jean Herrick 65 Martindale Avenue, Hudson Falls, Ny
(Name) (Address)
Relationship t0 the deceased N i e c e
Name of Funeral tkm. Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to tha best of my kxwA V%the (has) (M no)Pam ,deftriNator,battery,battery Pack,Power
call,radioactive irnptarrt or radioactive device in his or her Inch One)
I certify that I have full power and sulhad etion to arrange tar the aemedon of the remains and to dlrea the dispooklon of the
aaffu*W ream**,that any personal possessions he"eNtnar bean narnoved or may be daetrnyad,and agree to protect,defend and
save harmless Pkw View Crematorium from arty and ap cairns and demands tier loss or dsniaps;which may be made against them
by reason of or corm ecied wNh ft cremation of said romekts es dir mied,whether such dab,rs ar demands are or are not wholly
false c �rt
68 Main Street, Hudson Falls, NY
(Address)
65 Martindale Ave Hudson Falls Avenue
(Signature and Address of Relative or tegai Representative)
Signed on this date:
Disposition of Crernatad Remains
I hereby direct Pine View CreaukA rn to dtapose of the cremated remains as f0ftf s:.
Mail to
Other arrangemerus-Please specify:
If pulverization of cremated remains is requested,dmck here XX
RevhOo n:April 18,2007