Mayr, Diane f
�O O
P W E YY QUEEg�f3u
CEMETERY AND CREM
QUAKER ROAD, QUEENSBURY, NEW ATOR ORK 804
(518) 745•4476 (518) 745'-4-477
Funeral Director.Fame '
nce Of Cremation Casein-2 � -
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Time Cremation Started /
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Cremation Complet d 3yp�
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Town of Queerlsbury
Pirm View Cemetery and Cremalatwm
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The underaipned requests and W orims Pkre View CrenWorium,in aacwtimm v ft and tubjed to tts Rules and Regulations to
cremate the remsins of:
Diane L. Mayr fG IL
gp
(Name) n (S"
/8QB O.F1C� LQT lam! - /'1 i Ira 611a /VY /Z/?2'f
(S"d) (CNy) (SWe) (WP Cam)
vAm died on 7th dayof October 2008
at &CC 1..0 44- 14udsaro r*l�
( ) (Address)
Name and address at we me It %rr3ia w or Items of person authortanp aematim
(Name) (hem)
Ptskmortelrip to ttre deceased Husband
Carleton Funeral Home, Inc.
Name of Funeral Hama
IMPORTANT:
I represent then to the beet of my lagwled9%the deceased(tms) mercer,dettbrN aW,battery,battery Pam,pmw
+cell.rebioective knplent or redioacdve device in his or her body.(Ckde One)
i ow*that I have full power and wAvxiz Wn to arrange for the cn wn8*n of the far wft and to dkea the dispoebm of the
aemftd remains,that arty pateotml poeasesions have em ar been removed or may be deekoyed,and spree to proterL defend and
yore hartmisas pine View CrUM101i<a+l from arty end aN cial and dernands tior bw ar dsmapas whidt may be made apeklsi dram
by reason of or corxtetIed wNh the aametion of add remskw es dAwled.whedw such calms ar danleKrds are or ere rtat wholly
prourWbss,false or#brxwler
68 Main Street, Hudson Falls, NY
(yy ) (Address)
(SVvtura and Address of Relative or Legal Represereative)
Oct. 8, 2008
Sipped on this date:
Disposition of C mffw d Remains
I hereby dkect Pkw View Crematorium to dlapoee of the cremated remakrs as bNows:.
Mail to
OUw arranpemenls-Please specify:
tf puiverkoWn of cremated remains is requested,dredc here XX
RwAs Im April 18,2007