Farrell, Patricia OF QUEE9\�5oUr
PUYE YTEW CEMETERY AND QUAKER ROAD, QUEENSBURY CREMATORIUM
(518) 745.4476 ' NEW YORK 12804
(518) 745 4-477
Funeral Director
Name—
s c r c r 4 t-:,, rl 117�
Cae#
Date Of Cremation
Time Cremation
Started
�:Hb
Time Crema h
tion
Complete 30
Type of Container
SE
remarks
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fly
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a Mel
Town of Queensbury
Pine View Cettmotm and Cre lium
21 Quaker Road,Queensbury.New Yotk,12804
Cemetery offim 518-745-4476, tarn_619-746-4477
Authorizatian.to CreMSW
The undoc S9 regw.s w%d a,&.wx�Pk%o view,Cm.AM au9a,.�aeoocuez�oa�ord-eiea to rt.PhAes mod to
cremate the sew of:
Patricia Anne Farrell le
who oso on 13 th day of
GleTis Falls Hospital, Glens Fa12s .. NY
(Place) (Addness)
Nance and of neart�st�relalit/e or traroe oT pence: v
Mary Farrell PO Box 3543 Irid air Lakes NY 12842
MOM) (Address)
Relatiorz*to tne.deW&Wd- Mother
Name ofFuVralMOM Alexander-Baker Funeral Hoge
1MP0RrA1V'i':
I represent that to the best of my koo�the dew(heo.of(ttas no)paemreker, a my ot#w bOtteay opet Wd
device In his or her body, (C-ade OM)
I ow"that I have ftA.power o at to mrmtge t@r the cretrmgon ofifte to stis attd to dirad the dNxisidon of the
crtar and tat anY P possembmtam 6jmfrbwn ttattm wd or may:be destnoYed.:W d agree to PAAk%defer d w1d
t Pike View oriutrt jrom,wW aod m2ff cb pW demands far bw ordoi sMidt may be node themag&IM
.Of of Ultttf the aeis t or Sam 8s dbeCed;t t wr Sinai dabm, 0r danwos boo or we ro.t t d=By
( ) jAddFW54.
A
( and Ad�rjss of RetaYtra a�sSe#�?�): .
swmonmrsdate;. September 13, 200$ ':
()isposftlott of cronated Remains
I hereby direct pWre view CFemstn =to dispm of the cremated tertrairts as toitows:
tan to
Otter �►s_ �fY F H will pick 'up
if pulverizatJort of o'emated rarnairts is requested,check here--x
Revision:Jt�Y.�Q4
�Q�M,07
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