Hammond, Tammy OF
PINE QUEE9�5t3Urr
VIEW CEMETERY AND C
QUAKER REMATORIUM
ROAD,
Q�jEFNSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
_ Funeral Director
Name E G�
I�w�m S
Dace Of Crematd a27
i Case
on 2 0
T , me Cremation Started
S(:uo -
T : me Cremation
Completed
Type of Container Aft
or S
Remarks
U `t.00
lqo
# 327
Town of Quserlsbury
Pine View Cemetery and Cremaknium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Ofkn: (518)745-4476, Crematorium: (518)745-4477 -
Auttrorization to Cremate
The undwsijgred requests and author#ws Pkre view Crem0106um,In ea wdanoe with Ora subject to its Rules and Regulations to
mate me remains of:
Tammy Ann (Havens) Hammond Femal
(Name) (SOX)
5. Alma Ave Hudson Falls NY 12839-
(Shvm) (City) (State) (Zip Code)
veto died on 12 t h day d July 2008
at MOSS LUDINGTON Hospital Ticonderoga NY
(Pleas) ( )
Name and address o nearest lh*V releove or name of person audxwhdV aanation:
Tim Hammond 5 Alma Ave
(Name) (Address)
Reietlomft to the dEWa9ad Husband
Name of Funeral Fkx. Carleton Funeral Home, Inc.
IMPORTANT:
I represent tug to the beet of my knowledge,the deoeasad QWW#m no)pacemaker,ddbdM W,battery,ba tery pack,power
cK n mlkx .Ave knplent or radfoactWe In be in his or her body.(Garde One)
1 ow*that I#rare full powar and sutlwrhaftn to arrerge for the cremefto of the.e nslns end to drerx the dlepoee<lan of the
c ematad remains,mat any paraanal posesesions have etmar baen remroved or may be desk%,ed,and agree to protect,defend and
save horntbas Pbw\few CrsrtrokmWm from any and oN c#eirss and demands 1pr loss or dernages which maybe made agwat them
by nowind orcuriruxled wink dre - add remains eas directed,wtmdai suds clod garde no de are or ere not wholly
falm
r�1J1 68 Main Street, Hudson Falls, NY
(Ad*qos)
5 Alma Ave, Hudson Falls, NY
(Sgnatura Address of Relative or t egai RepreaerNetive)
Signed on this date:
Disposkion of Cm meted Remake
I hereby direct Pine View Crematorium to of ft cmmx tad remake as%laws-
Mail is
Other arre rVernerm-Pleene spar.
If pAveraetian of cremated remains is requeeW,dm&here XX
RevFsian:April 18,2007