Alden, Cecil OF QUEE9�50up,,y
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEE.NSBURY NEW YORK 12804
(518) 745-4476 (518) 745--4-477
Funeral Director
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Time Cremation Completed
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Town of Queensbury
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 NO cut wrtws Pure View Mtn,In accordance with and subject to its Rules and Regulations to
c rernate the of:
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(stream) ]� (city) (State)who died on
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at ( ) (Address)
Name a name of parson aematiore t
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(Name)
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Relationship to the deceased -gv 4
Name of Funeral Home
IMPORTANT: no) .battery,battery tom.power
I represent that to the bast radio®dtwe dam my .ft In or her body.
radloecxive implantor
I certiry that I hem full power and authorization to arrange for the caoemadort of the mnoins and to dyed the deposition of the
aena>and remains.so any personnel poasmions have etdrer been renro+red or may be destroyed,and ages to proied.defend and
save hanrdaas Pine View Cemebortum from arty and eM claims and demands for loss or damages which may be made against them
by reason of or connected vAh the aema*m of said remaha as dreclad.rrMetiter ouch cleirrs or demands arr3 or are not wholly
false ar
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and of or UGei Represenzativej
Signed on this date: 6
Opposition of Cremated Remains
I hereby direct Pine View Crernelaium to dispose of the cremated rernains as 1501IM :
Mail to
Ouner arrangements-Please specify:
If pulverization of cremated remains is requested.check hem
Revision:April 18,2007