Ellinger, Richard i
TO
"MN OF QU EE B
PINE YT E W C ��� u� `J
EMZTE'RY AND CREMATORIUM
gtAkaR ROAD, QUEENSHURY NEW YORK 12804
(518) 745.4476 (518) 745.-4477
Funeral Director 1
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Oate Of Cremation
Tame Cremation Started
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Time Cremation Completed
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Type of Container
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�emarks
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Town of Queensbury
Pine View Cemetiery and CrerrtatadUm
21 Quaker Road,Queensdury, New York, 12844
Cemetery Of(iae: (518)745-4476, CreFrretorium: (518)745-4477
Auftwizaldon to Cremate
The WXWM%FW reguesis and aulttorass Pine View Crentatoriunt.in accordance wkh and subject to ks Rubs and ReguMbrrs to
dentate the rerrreins d: M
Richard Ellinger
Nottingham Dri�ieensbury NY 12804-
(SU") (CRY) (Scats) (Zip Cam)
who died on
�D�dl j day of 01/12/2009 20_
at Glens Falls Hospital
Glens Falls NY
(Place) ( )
NO"and eddraw d nearest IWbV nth or rwme of Person aurhorts*V awneffim:
Cynthia Ellinger 3 Nottingham Drive
(Nam) Wife (Address)
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RelattorOW 10 the deceased
Carleton Funeral Home, Inc.
Name d Funeral Home �
IMPORTANT: the deceased(tree) (has no) ,defbriNelor,beft V.baaPad(, O
ery P •P
I repremo that to tfta best of+try tatvwledge,
cell,redioecdve k q W t or nugoacom mice in his or her body.(
I oerWy that I tow full Power and eudrorfzetion to emerge for the cse NODn of Bra remains and to direct the dMPoekian of the
rarr►ekre,drat arty persUAW poeesesione have ON Wr bears removed ar
or may be desWyed, e agree to Pr sM defend and
crartretad
cave ftert rwrkVes Pine view Q�errte�ortwrt from arty and all claims and dantartds for bee or darttagas tee nwY be made againsttfttrm of or corwmxftd With the uarttetion of said rerrtatra as dlreded,whedter such clairtrs or dernands ere or are rtot wholly
fates or fiauduwartt.
68 Main Street, Hudson Falls, NY
Nottingham( inghham Drive j
( end Addmss d or Legal PWprwMte")
Signed on this dote: u i i i �f7Cti
Disposkion of Cremated Ramiro
died Pine Vlaw CfemalOrkn to dispose d the pematad remQft as fONows.
1 hereby �
Mali to
Other arrengernerm-Plaees specify:
tf pulvermetion of cremated rernaim is mgjagted,check Rene XX
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Revisiart:April 19,2W7