Frommer, Mary Ellen rrO
OF PINE 'YI QUEE9�,(5oU
EW CEMETERY AND 1
QUAKER ROAD. QUEENSS CREMATORIUM
URYi NEW YORK 12804
(S18) 745.4�76 (518) 745'-4.477
Funeral Director
.Fame Mwr wr/t o
Once Of Cremation Case#. tj
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Time Cremation
Started
T , me Cremation Com
pleted 10: 20
Ty ?e of Container ------------
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Remarks row 1SI C
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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
Auftnizallion to Cremate
The undersigned raquests and aullwdms Pine View CrenWorlum,In aooardanoe wkh and subject to Its Rules and Regulations to
cmrsate the remains d:
Mary Ellen Frommer F
(Nerve) (Seat)
2.431 Burgoyne Avdiiu son Falls NY 12839-
(Sul") (City) (State) (Zip Code)
who died on day 09/14/2008 20_
at 2431 Burgoyne Ave. , Hudson Falls, NY 12839
(Place) (Address)
Name and address of rhearad INft mfletive or name of Mersa►authori;&ng awmetion:
Mr. William Robison 2431 Burgoyne Ave.
(Name) (Address)
Reiationov to the dwea9ed S o n
NamedFumalHome Carleton Funeral Home, Inc.
IMPORTANT:
l reprasent that to the bed of my knowledge,the deceased(hes)g#L=fn1D ,da�rifbior,be ttto y,m er,ay p power
coo,radloacdv�e implantur nKloactive device In his or her body.( )
10W*that I have to power and nuawruation w amango for the asnud t of the renaft and to drect the disposition of the
aermftd remains,that any peraonai possoadme have 9M ON ban n removed or may be deft oyad,and agree to prdecL defend and
gave hamVM PMe View CrernetoFk m from eW sad aN calms and demands f or ion ar darrrspes which may be made against them
Wmqwn of or canmcled wkh tl»asmation of add heard w es diaMd,whether such dab,ts ar dertiertds are or eve not wholly
fain or
68 Main Street, Hudson Falls, NY
JWIb ass) (Address)
� son Falls, NY
Address of Relative or pregeMetNe)
Signed on this date. �`j U
Dispwkk)n of Cremated Remain
I hereby direct Pine View Crematorium to dispose of the aemeted m males as"Ows:.
Mail to
Other arranganents-Please spec fy.
if pulverization of Cremated mmains is requested,check here XX
Revision:ApM 18,2007