Bickford, Phyllis OF QUEEN,5Bu2
PLNE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745•-4477
Funeral Director
Fame— ti
-�� icy osG Case#
Date Of Cremation
UC40 a17 TZ Z
Time Cremation Started
T 1 m e Cremation Completed � ' 7p
Type of Container ood �
Css�Ce'� �
1��• t"�,IC ? I T cH S�
Remarks
Uv 70
Ad
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,1
Town of Queensbury
Pine View Cemetery and Cremakmium
21 Quaker Road,Queensbury, New York, 178o4
Cemetery Qfiiae: (518)745-4476, Crematorium: (518)7454477 '
Authorization to Cremate
The undersigned requests and autltorit es Pine View Cremekorlum,In sawrdence with wid subject to Its Rules and ReWmions to
crernme the remains or:
Phyllis Cathy (Barrett) Bickford F
(Name) (Sea)
24 Ethan Allen St. Fort Edward NY 12828-
(Shim) (City) (we) (ZJp Code)
vft died on 17th day of October 20
at FORT HUDSON HEALTH CARE FACFort Edward NY
( ) ( )
Name and address of merest ih*og relol re or name of peso *uMoridrtg uemalion:
Merton Bickford 24 Ethan Allen Street, Ft Edward, NY
(Name) (Address)
Reiedi mt ip to the de0a998d Husband
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I repr+ewt Vial to the best of my knowledge,the deoeasad(hop)or On no)pecems1w,dellbriAator,boary,battery per,power
call.radioactive implant or nxkwcdw deeioe in this or her body.(Cirde One)
I c erW out 1#rave*A power and aetdwiz atlon to anange for the cremation of the rarna to and to direct the disposition of the
cremated remains,that any pwwml posseedons have eillm beery removed or maybe deft Dyed,end agree to protect,defend and
save hannteets Pine View CremetaAm from any and all a lairns and demands for Ion or damages wife)##may be made against them
by reason of or connected wkh tlw arert alkm of add rend*as direcled.wllellter such clairtts ads...arrdo are or we not wholly
grou ,false or TreudviaM.
2� 68 Main Street, Hudson Falls, NY
, (Address)� Et Allen St. , Ft. Edward, NY
(Signature ON AddresfW Rein"or Legal Representative)
Signed on this date:
Disposition al Cremated Remains
I Hereby direct Pine View Cremalw1u t to depose of the crammed remains as ToHoars:.
Mail to
Other arrangements-Please speclry:
If pulverization of cremated remains a regemsted,d**beta XX
Revision:April 18,2007