Cobb, Donna Mae e•
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METERY AND CREMATORIUM
QVAXF_R ROA' D, QUEENSBURY'
NEW YORK 12804
(518) 745-4476
(S 18) 745-4477
Funeral Director
Case#
Date Of Cremation
Time Z00$'
Cremation Started
l:ro
Tame Cremation Completed
LOOP
Type of Container CrA
Remarks 5
(:20
MWVE 1=op M
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Town of Quem""ry
Pine View Cemewy and Crematoffium
21 Quaker Road,Queensbury, New York, 12844
Cemetery Office: (518)745-4476, Crematorium: (518)745.4477
Awn to Cremate
The Undwaigned requeft and audxxWm Pk*View Grew kw1um,In accordance with wo subjod to Its Rubs and Regulotmm to
c remew the remakte Ct
Donna Mae Cobb F
(Name) (Sex)
169 Tenth Street Troy NY 12180
(Shvd) {City) ( ) (Zip Code)
who died on day d 101111200 8 20_
at Glens Falls Hospital Glens Falls NY
(ftm) (Address)
Name and address of nearest IMrtp mkdve or name of person autfXwb tp c mntation:
Patricia Zahaba 316 Main Street
(Name) (Addmw)
RekMonqNp to the deceased Da ugh t e r
No. offtnaralFkx. Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the boat of rtry kwwbdg%the deaeaood(itsa) pamvW er,ddfbriN t.baftV,ba Wy peck,power
Cell,radloec1m Implant or radioactive dwice in his or her body.(ar )
1 oardly that I have 6A power and autttorWWon to anango for thm cammmatbn or the nm ske and to dlrorx the dispoafflm of the
creffaked tamakts,60 any Pw nal poeeoeMMM have aIdW bean removed or may be deskayed,and agree to protect,defend and
save tW Mesa Pine View Crettteimium from arty and aI cieims and demands U bw ar damapas which maybe made against them
by reason d or wFocled wph 1M cm adon of add mmakta es d reded whodw a ich claktts ar da -artdo are or are not wholly
fall`me�o►fi�*dulwc
68 Main Street, Hudson Falls, NY
r' (wfbtasa) ( )
16 Main Street,Hudson Falls, NY
1, L
avid Address of Relative or t"d Reprerser*Wve)
Signed an tfMs date.
Dispwkkm of Cf rt @W Remake
I hereby dined Pkte Vkrw Cren ai orktm to dispose of rite aemetod remekts as follows:.
Mail to
Other arnwKWnerris-Please spedfy.
ff ptrlverastian of avmafed rmmnms is rmWesled,dm&hens XX
Reviskvt"18,2W7