Vanguilder, Joyce p F QUEE9\ 5o U
WE VIEW CEM TERM 1
qtj, Q
ROAD, ' AND CREMATORIUM
UEENSBURY, NEW YORK 1280,
(518) 745.4476 (518) 745'.4.477
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Name FUneral Director
Jo �
�.• L � y Case#. �G Date Of Cremation
Time Cremation Started
I �
Time Cremation Completed
Type of Container
RemarKs � Z1'0 (As�,: +O�
v�. -2 ,n P
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Town of Queensbury
Pine View Cemetery and Clremataium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)7454476, Crematorium: (518)745.4477
Authorization to Cremate
The undwwgrmd n queels and autwxttee Pine View Crenwadum,in eacordenm witty and stMed to ks Rubs and Regriations to
e n we the remains d:
Joyce Elaine (Leppard) F
(Name) {Sex)
Pleasent Argyle NY 12809-
(Stned) (CRY) (Swe) (ZIP Oade)
vviv died on dayd 12/26/2008 20_
A PLEASANT VALLEY NURSING Argyle NY
PAM) (Address)
Name and address d neerest living reletive a name d person authork&V aenr11V=
Michael Mattison 170-4 Bluebird Road
(Name) (Address)
�d" dSon
NertredPurerdFiarre Carleton Funeral Home, Inc.
IMPORTANT:
i repew the to the best of my kwwbdpe,the d—mmo d#mXE�v �
) ,deftWO r,bWarY,�Y Pam.pow
aak radioecOve impiertt or nk*mc tho device in hie ova t�odr.
1 oar*that l have tin•power and au*Kwbatlon to arrange for the crernadont of Via retrains and to direct the dispositkm of the
crertw"d ramairs,that any personei poseessions true nifner been tatnoved or may be desmrayed,and spree to protect,defend and
save ttartntees treatahx nt from any and 91 tdain s and demands for does or damages which maybe made a0ai iA them
by resem of wkh of avid remains as diested,whedw such dam ms ar den'iarrds are or ere not wholy
68 Main Street, Hudson Falls, NY
( )
170-4 Bluebird
(Siptattae Address of Relpt w or Legd Representative)
Signed on this date:
Diepoekkm of C,reffaded Remains
i hereby direct Pine View Crenude um to dispose of the cremated remains as f0110":.
Mail to
Other anwVe"wft-Piesse epBW-
tf ptrlveraetiarr of cremated remains is requested,dm&here XX
Revis=Apia 18,2007