Murray, Edna OF
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PINE 'YIEW CEMETERY AND C
QUAKER ROAD REMATORIUM
Q�FNSBURY, NEW YORK 128C4
(518) 745-4476 (518) 745-4-477
Funeral Director ���CLTo�
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Time Cremation Started
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Remarks
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Town of Queensbury
Pirtle View Certollary and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery OR*: (518)7454476, Crematorium: (518)745-4477 '
Authorization to Cremate
The undsrsipnett requests and athlhorttea Pkre View Cremaforwm,In aacordanCe with aro subject to Its RL"s and Regulations to
cremate the ternekrs of:
Edna Murray F
(Name) (Seat)
Fort Hudson HCF FcFk:trtEcRdwa±d NY 12828-
(811ee1) (City) (State) (Zip Code)
who dW on 2 7 t h day d July 2D 0 8
at FORT HUDSON HEALTH CARE FACFort Edward NY
O O
Name and address of ON am living ntiat"or name of person aumort ft aannemm
Bernard Coffey 87 Lamplighter Acres Fort Edward, NY 12828
(Name) (Address)
Rdiatlorehip to the deceased Son
Name or FuneralFionre Carleton Funeral Home, Inc.
IMPORTANT:
I rapasent that to the beat of my laxw ledge,the deceased(has)or(has no)pacemaker,defibrillator,battery,battery pact,power
call,radioactive inO"or tadtoectIve device in his or her body.(Croce One)
1 cer*that 1 have full power and aulbonimtlon to arrange for the c rematbn of do remakhs and to direct the dispoattion of the
crammed remake,that any pera nal possesslorts have mUmr been rarrroved or may be destroyed,and agree to pndect,defend and
save hermbs8 Plne View CremeWrkrm from any and aN dakrts and demards for ltlss or damages whieh may be made aghktet dhem
by reeaon or acvrInetled wkh tlts cremsdcn of remakes as direcfed,whOw such dabs or rip- m-ds are or are not wholly
or
77/ !! f alse
68 Main Street, Hudson Falls, NY
(yVltnesa (Address)
rf 87 Lamplighter Acres Ft Edward, Ny 12828
( Address of Rem or Legai Represents")
Signed on this date: Z b- I l'
Disposition or Cremated Reff*We
I hereby d rect Pine View Crematorium to dlapose of the crammed mted remake as*Mows:.
Mail to
Other arrangements-Please spedfy:
If ptrlver¢stion of Cremated remains is regtassted,check here XX
Revlsrkxr:April 18,2007