Brown, Linda rrn
OF
PLNE Y7 QUEEg\�5(Bur
r
VIEW CEMETERY AND
QUA}CF-R ROAD CREMATORIUM
QUEENSBURY. NEW YORK l2804
(518) 745.4476 (518) 745.-4-477
Name Funeral Director
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C Da a s e#te Of Cremation 5
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Time Cremation Started
T :me Cremation
Completed
Type of Container 1'vr,�a Cis
Remarks
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Town of Queensbury
Rine Yew 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 and au#Meaes Pine View Gramm orlum,in aocardarm with and subject to its Rules and Regulations to
cremate the remains of:
Linda Lee (Bardin) Brown F
(Name) (San)
127 County Route Fit Edward NY 12828-
(Strset) (CRY) (State) (Wp Code)
who died on 5th dqY()f September 2005
at Glens Falls Hospital Glens Falls NY
(per) (Address)
Name and address of rrerarest living relative or name of perscxt authorizing arernatien:
Virginia Mickel 103 County Route 46, Ft. Edward, NY
(Name) (Address)
Relatlorrship to the deceased Daughter
Carleton Funeral Home, Inc.
Name of Funeral Horne
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has) (ttas ,de ffillaW,batoary,battery peck,power
ce-N,radioecove implant or radioactive device in his or her body.(C )
I certify that I have full power and auffwrbzdon to arrange far the c mmadon of the rernaft and to direct the d6posOlon of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to pr leM defend and
save harmless ph*View Cremalmium from any and all claims and demands for bsa or damages Mich may be made against them
by reason of or cared with the cremation of said rameins as directed,whether such daims or demands are or are not wholly
false or 1.
9rx� 68 Main Street, Hudson Falls, NY
fffiness) 10` o ty Route 4 6 Fort Edward, NY 12828
(Signat s and of Relative or Legal Representative)
Sept. 8, 2008
Signed on this date:
Disposition of C,wneted Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as bNOWs:.
Mail to
Other arrangements-Please specify:
tf pulver¢etien of Cremated remains is requested,crack here XX
Revision:April 19,2007