Wenchell, Annette �O OF QUEE9,QOUTO,
PINE V1EW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director_
Fame nfti `� i.,c�t �� `
Case#
Date Of Cremati.on
Nuvtm r�'" Z
U
Time Cremation Started
1z, Ss
Tame Cremation Completed 3,U N.
Type of Container
Remarks
Uvi— Z ell
,� nn
(oo L
# s��
Tom of Queefw"
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, Now York, 12804
Cemetery OR*: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The undersigned requests and arrlhorI sa Fvm View Crematorium,in aacordence with and subject to Its Rules and Regulations to
cremate the rernains of.
Annette Marie Wenchel F
(Name) (Sex)
Wesley Health Care Springs NY 12866-
(stred) (CRY) (Swe) (7J p Code)
who died on day of 11/07/2008 20_
at Saratoga Hospital Saratoga Springs NY
(Plane) (►fig)
Name and address of nearest IMV nletzive or name of person autitortdttg aremagm
Mrs. Betty Stark 127 Bay Street
(Name) (Address)
R ftto Sister
Narne d Funeral Fkx. Carleton Funeral Home, Inc.
IMPORTANT:
f representreeent that tQ the best of my tarvwledgo,flue deceased(has) &dbrflolor,battery,be"Pew,power
C��rgy�aoemeker,
cal,radioect ve imptanf or radioecWe device in his or her body.( )
I cerWy Bret I have ft/power and eudwrimtlon to arrange for the caemagon of the remakts and to dIrW the dispoebm of the
cramated tanx",that any personal poasaesiotts have eN ar tteen removed or my be dafttityed,and agree to protect,defend and
save twmless Pk*View Createlorkm from arty and eN dal ras and demands far bee ar dernaps which mey be made aponst them
by reason d or cvrnecied wkh fu caannoon of add tetnalrm ass dbechod.whether such dairts or derrrardo are or art:not wholly
false or fiaudulenL
68 Main Street, Hudson Falls, NY
-'J-. f �'L
( ) (ate)
127 Bay Street
and Address of Relative or Legal Repreaeraettve)
Signed on this[fate: 17- 60
Dispoaibon of CrameW Remain
I hereby Bred Pine View Crernal dufn to dtspoae of<fte cremated remains as fbKowrs:.
MMI to
Outer arrartgamerrta-Pleas sped*!.
If puly bshon of Cremated remains m r�egtAsled,check two XX
Revision:April 18,2007