McLean, Ann E
�Q O
F QUEE9�5oUrPINEWE VIE . �..J
CEMETERY AND CREMATORIUM QUA CER ROAD, Q�ENSB LRY NEW YORK 12804
(518) 745.4-476 (518) 745'•4.477
Funeral Director
Name
Cased
Date Of Cremation
L,
Time Cremation Started
Tame Cremation Completed
�3u
Type of . 1.N
Container / f1
`�Aw v� 0 C" C
Remarks
F 3Y3
Town of Queens"
Pine View Cemetery and Cremakni um
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477 '
Auftmizefion to Cremate
The undersigned requests and aulhorfaes Phe view Ownsiodum,In as mrdancewkh and sabjad to Its Rules and Regulations to
aemme the remains of:
Ann McLean F
(Name) (SOX)
7s ) (swe) (ZJp Code)
vdro died on day of 10/2 4/2 0 0 8 20_
at Glens Falls Hospital Glens Falls NY
(Plam) O
Name and address of nearaet living relatrae or name of person aulhoraft cremation:
Debbie Huls
(Nance) (Address)
Retatlomlp to the domed Daughter
Named Funeral 1lonre Carleton Funeral Home, Inc.
IMPORTANT:
I repreearrt that to the best of my knowledge,the deceased(has)or the8 no)paaerraaker,defibrillalar,battery,battery pads,power
cell,reddloscom implant or radioactive device in his or her body.(Chde One)
I oertlry @rat I here U power and autlwftaWn to arrange for the aemedon of the remains end to dVw the drsposilion of the
aamatod remains,that any personal poeeaesiorts have oMmm been removed or may be desbvpvd,and agree to prdect,defend and
save here km Pima view ern from avoid all claims and demends for loss ur damages rrrdch may be made agairatt them
by reason cf or con FmMd vAh fM cremation of said remains as dAwftd,wlWw&Kh claims or dertrand8 are or are not wholly
� lsefa or f aud
�� ulwt'6� 68 Main Street, Hudson Falls, NY
ChInass) (Address}
(>,L- � .
(signature mid Address of Relati4e or Legal ftpresentatMe)
Signed on this date:
oisposkion of Cremated Remains
I hereby drea Pine Vlew Cremalorlun to dispose of Via aematad remains as foilaWs:.
Mail to
other anangernaft-Please spe
If pulverization of cremated remains is rued,check here XX
Ftevisim:April 18,2007