Roth, Joseph OF UE
PINE 'VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QCIEENSBURY fix, YORK 12804
(518) 745-4476 (518) 745-4477
ja44 Funeral Director
Fame
Date Of Cremation ;--) Q
Time Cremation Started 30
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Tame Cremation Completed :1splyj
Txpe of Container
Remarks C�-�
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Town of Queensbury
Pine View Cemetery and Cremae dum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745- 477
Authorization to Cremate
The ttrdwvigr ed"Kpgob and audmritea Pine View Cmweiorlum,In aaoordwm wfth and StAod to its Rubs and Regubtions to
Ca*rrtete the remains or.
Joseph Edward Rath M
(Name) (Seat)
69 Tanglewood Drive, South Glens Falls NY 12803-
(Stn3et) (City) Owe) (aP Code)
who dad on day of 0 7/11/2 0 0 8 20_
at 69 Tanglewood Drive Moreau NY
( ) (Address)
Nam*and addrase of ttaereat IWbV r+eie o or name of pow sLdx rt&V aenmtlort:
Marilyn O'Neil 69 Tanglewood Drive, South Glens Falls,NY
( ) (Address)
ReWVoW1ip to the deC9asad Mother
Nemeof Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent Out to tit*beet of my lawwbdge,the deoe*sad(has)or no) ,deftdNOW,bdWrY,beitery Pads.power
04 nedioacdve irrg*Wd or nKkmcow devioe in his or her body.(Cirde
0W*that I have U power end awtwrb adon fo arrange for th*caws ort of the ramakts and to ftw the disposition of the
cremated rantatrts,gamy persona(posesesiorm have ether been rerttoved or may be deft'oyrtd,end ages to pnAwd,defend and
save hanrftea Pine Vk w Cremebxiutt from any erd aN dab and demands for toss or dentages which may be mad*agondt Own
reason of or can acwd wNh tf t*aarr odm of add rwv**a9 d W9d,whedw such drA s or de enb are or are not whoNy
fob*or ,
(/nP�� S 68 Main Street, Hudson Falls, NY
(yyN�) (Address)
r`� 69 Tanglewood Drive , South Glens Falls,NY
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and Address Re%*W or i..egW RepreeerAWW)
July 18, 2008
Signed on this date:
DiSsposkion of Cremated Remains
I hereby dhect Pine View Cmntatorktnt to depose of the aem*ted remains as b NOws:.
Mdl to
Other arrengernertla-Pkiese WOW
-
If puivedwdon of Cremated remains is mgetested,dedr here XX
Revlsiarc April 18,2007