Colvin, Nancy i
TO 2� OF
QUEE9\�5tBUr
pWE �.
VIEW CEMETERY AND CRE
QU'�-R ROAD, QUEENS$URy MATORIUM
-4476
(518) 745 NEW YORK 12804
(518) 745..4�477
Funeral Director 1
Fame
Date O o
f Cremati. n 3SU
/� vet y Case#200$
T :me Cremation
Started
T =me Cremation
Completed 10' S0 n
Type of Container
Remarks
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Town of Queensbury
Pine View Cemetery and Crematodum
21 Quaker Road,QueensWry, New York, 12MM
Cemetery 4tflce: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersign'd requests and euftrtaes Pine View Cremarorium,in acowdenoewith artd subject to its Rules and Regulations to
aernate the nNne is of
Nancy Jo (Moumblo) Colvin F
(Name) (Sea)
14 Stewart Ave South Glens Falls NY 12803-
(sUW) (City) (Steen) WP Code)
%ft died on The 31st day of July 2008
at 14 Stewart Ave South Glens Falls NY
( ) (Address)
Nerve and address of 10a DO living relative or name of person atrthoridng caemetion:
David Colvin 14 Stewart Ave
(Name) (Address)
RftftoKp to the deceeeed Husband
Name ofFLirm at Home Carleton Funeral Home, Inc.
IMPORTANT:
l represent that to the bast of my tawwledge,the deceased(has)ar a nD oerrraker,deflb Ular,bettery,fiery per,power
dell.radioective knpiartt or redioective device in his or her body.{ e
1 certify that I have file)power and sulharitatbn to an wW for the cremadon of the rernekts end to direct the despowlan of the
aamated ramekts,that any PW90nW Poesaesbrtt have&ther been removed or may be destroyed,and agree to protect,dafiand and
save hentnees Pk*View C rSMStrxltmr from arty and aN tiairtts and demands for ices ar damages which maybe made against tlnam
by reason of a cornec6ed wink the aarnetion of add n winkre eta dkWed,whether arch dab, ar demerids are or ere not wholy
groundless,false or f+atrdederq.
68 Main Street, Hudson Falls, NY
(WIness) (Address)
14 Stewart Ave, South Glens Falls
and of Relative or Legal RepresertNom)
Signed on this date:
Disposk on of Cremated Remains
I hereby direct Pine View Crentetorlum to dispose of the cremated remains as foNowe:.
Mail to
Outer arrangements-Please specify_
If per wketion of cremated remains is mWested,d*&here XX
Revisi wL April 18,2007