Tripp, Jeanne F QU EE
PINE VIEW �� �
CEMETERY AND CREMATORIUM
��KFR ROAD, QtJEENSBURY NEW YORK 12804
(518) 745.4.476 (518) 745-4.477
Funera 1 Director
Name J eon" l'
�s' Cased. n53
Date Of Cremation
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Time Cremation Started
Time Cremation Completed a
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Type of Container
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Remarks o w,
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Town of Queensbury
Pine View CemeWy and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)7454476, Crematorium: (518)7454477 '
Authorization to Cremate
The undersigned mWm is and autlhoriaes Pine View Gtemeforium,In as wdenoe with and&ti'ed to ks Rules and Regulations to
cremate tie remains oF.
Jeanne Ann (McCarthy) Tripp F
(Flame) (Sex)
Northeast Center K)a1g--Rp=ial care NY 12402
(Street) (CRY) (State) (Zip Code)
who died on 29th dayd November 2008
at Kingston Hosptial Kingston NY
(Plece) O
Name and address of noeraal living roletiv�e or name of pasm akthabng c emot
Denise Pacher 16 1/2 Baker Street, Hudson Falls, NY 12839
(Nam) (Address)
ReiationsKV to tie deCeaeed Step Sister
Nam of Funeral Rx. Carleton Funeral Home, Inc.
IMPORTANT:
I represent tier to tie beat of my .the (W)or 0105 no)pier,deflb our,batfay,battery peck,power
cell,radioective Imptaru or n0oac tin le,ioa in his or her body.(Circe one)
I certify Oral 11 6A power and audwrtsation to arrange nor the cranadw o1 the remains and to direct the d*)owjon of to
cremated remains,Do any penxmW poeeaesiorta have eN a thaen removed or maybe destroyed,and agree to prdeGt,defend and
save harmless PMa View Cramelorium from arty and all csims and demands for toss or dernages whkh may be made egWid them
by resaorh or a casheded with Zia c nirimdon of meld tetrhek as dkeslad,whatiha such d0i a dartrerrds are cr are not wholly
fate or fie dtrlenl
68 Main Street, Hudson Falls, NY
� cAdd�ss)
. � 16 1/2 Baker Street, Hudson Falls, NY 12839
(�C /\
(Signuture and Address of PhAstim or Legal Represenlellve)
Signed on this date. Dec. 3, 2008 _
Disposition of Crammed Remains
1 hereby direct Pine View Crematorium to dispose of the cremated remains as follows:.
Mail b
Other arrangernerm-Please wow.
If pkdveraatian of Cremated remains is wgcealed,check here XX
Revisiart:April 18,2007