Condon, Ellen TO O QU
EM�TERY ,� 1 �J
�i��IK�.R ROAD, QUE�'NS$�� CREMATORIUM
(518) 745.4.4�6 NEw YORK �z80a
(518) 745'.4.477
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TOM of Queensbury
Pine View Cemewy and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)7454477
Authorization to Cremate
The undersigned requems and authorizes Pine View Crematorium,In accordance with and subject to Its Rules and Regulatkm to
cremate the remains of:
Ellen Janice (Comar) Condon F
(Nam) (Sent)
8 West Street Hudson Falls NY 12839
(Street) (CRY) (Stela) (ZJp Code)
who died on 3 1 s t dgN0f January 2008
at Glens Falls Hospital Glens Falls NY
(place) (Address)
Norno and address of nearest Itvirrg r+eWW a name of pawn aLoxwtrirtp awn sdon:
Mrs. Caroline Condon-Lewis 405 Beaverbrook Dr, Pa Furnace, Pa
(Name) (Address)
Relationship to the deoassed D a u g h t e r
Nome d Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the beat of my knowledge,lino deoeaaed(ties) (has no ekes,deftNotor,battery,battery Rack,Power
call,redloaative implant or radioacdve dance in his or her body.
i ow*that I have AA power and authorization to arrange for the cremedon of the remains end to direct the disposition of the
cremated remelts,that any personal possessiom have sinner been removed or may be deskoyad,and auras to pnolmt,defend and
am ham lets Ph*View Crer akvium from emir and all cWrrs and demands for toes or dsrnages which may be made agsk al them
by mason of or con nec ied whit dw c mmetion of add remains es dYectod.whether such deims or demertcls are or ere not wholly
_ror
�� 68 Main Street, Hudson Falls, NY
(Address)
405 Beaverbrook Dr. , Pa Furnace PA
a�'1 v1- Leis
(Signature aN Aftesss of relative or Legal Representative)
Signed on this date: I ( /')�
Dispooklon of Cremated Remains
I hereby direct Pare View Crematorium to dispose of the cremated remains as follows'.
Mail to
Other arrangements-Please specify:
if puNerboion of cremated remains is requested,check here XX
Revi$kxr.April 18,2007