Reynolds, Linda F QUEE
PWECEMlrTERY ���� U,�
't�L'f7lJCF_1t ROAD, AND CREMATORIUM
QVESg�Y NrEW YORK 12804(518) 745,4476 (518) 745*.4.477
Funeral '
JI ( Director
.FameulCl
Oate Of Cremation _ Cased
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Cremation Started
T ; m �Z .,IQ
e Cremation Completed
Tr ?e of Container
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Tom of Queensbury
Pine View Cemetery and Cremskmium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The w dersipmd requests and audlartess Pine View Cremetariurn,In a000rdance with and subject to Its Rubs and Regulations to
creauge,the remains of:
Linda (Reynolds) Reynolds F
(Name) (SM)
5 Chelsea Square Hudson Falls NY 12839-
(Strm) (City) (State) (ZJp Code)
v"djedon 1st day February 2009
at 5 Chelsea Square Hudson Falls NY
(Piece') (Address)
Name arm addre'',/s�Ps of naareat living nebowe/1/or n///alltme/) '/
oyyff peso nawhhorm(/v crematia :
(Name) (Address)
RelatlonsPip to the deceased 1.5 Y�
Name ofFunualiiorrre Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the beat of my kwwbdg%the down~ peoen re w,defibrillator,battery,belfty per,power
0a,m dloecdva implant or ractoec Live device inhis or her body.{
9Q
I ow*that I here firl pourer and eudwri¢ation to arrange for the c remadon of Ure remalns end to direct the dispoWian of the
cramaW remains,that any pem anal possessions have eilnar A n removed or may be deskayed,and agree to prdect,defend and
sere ham*m Pine New CreoWm krm from arty end al daitrts and demertde for im or derrtsjps whkh maybe made egairtat them
by ressun ct or conrtecbd wilt the cremation of odd remalrns as dYiected,whether such daifr+s or der weds are or era rtot wholly
�/�
.
68 Main Street, Hudson Falls, NY
O
(Signature arxt of Relative or Lwal Representative)
Signed on this date:al 0 c1
DiVosNion of Cremated Remains
I hereby dined Pine Vkw Crematorium to depose of the cremated remains es bNaws:.
Mail to
Other arrwKWn nts-Pleesa'apedfy:
if per mbstion of cxemated remains is mWested,drecc here XX
IFtevlsi .April 18,2007