Tyler, Benjamin rl-c O
P LN E YT E W g
�U�R RO/CD.E"TERY ANC CREMATORI
QVE�S13VRY. N'S
(518) 7a5.4� YOR}C 12
U76 (518) 7a5..a.g77
ivn eral Director tEr�
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Town of Queensbury
Pine View Cemefry and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office. (518)7454476, Crematorium-, (518)745-4477 '
Audxxb t)on to Cremate
The un dwsoW requesfs and e M abe�s Pk*View gym,In amordwm with and au*d to kx Rufes and Regutatiwm to
dertt�the rentekts of:
Vev13u ,,vi�� de male
048m) (SO
24 pearl St. , Hudson Falls, NY 12839
(SI11 at) (CRY) (Wp Code)
yA,died on 26th day01 March 2p 09
at 24 Pearl St. , Hudson Falls
( ) (A,ddimm)
Name and address of rtRrareat Mvtap tt+*Wvo or mime of pown authorb*V mw wtlorn
Joanna Monroe 24 Pearl St. , Hudson Falls, NY
(Name) (Aetdress)
RetatwMft to that deoweed daughter
NwwdFwwxaIHww Carleton Funeral Home, Inc.
IMPORTANT:
f mwe"t that to the best of my WwMedp,the dvr eretrd Qw)or(hie no)pectetna w,de kd$e r,beery,bowy pm*.power
oeN,radoegcdve i 1vft t or tadaacthm devkm In his or hw body.(Ck*One)
I Ow*IM R i tame AA poww end Whartaatiom to am W for 00 OW0000n of the r mwft end to dWW the diepaeirbn of ttw
aanrafad mm*w 00 w W pareand poeaaasiorar have Sparc been ramovad or may be d mtroyed,and Ww to protect,derend and
aft*harmom Pkw View CromOrium ftm wy and aN del and dwnwWs tr Im cr damiapas whidt may be made againat ttxxm
bylopq dor�canywcW wNh ttm cnowdon of acrid carnets as d mcleid,whether suds clain ar demremds are w era not whoNy
n,
v� J Carleton Funeral Home, Inc.
(W ness) (Ad*m)
Hudson Falls, NY
1\ (fie and Addreas of N etatim or Lsd Reprr wive)
Sued on this date: March 26 , 2009
Deposition of Cmmtated Remains
i hereby diced Pk*View Crernetodw to diepoae of Use cremated m ffiaim as Wow
Mail to
curer smovww a-Pieaea sperltjr
ff ptdvertaetton of Cne►T€rW rmrrwko Is mqmW,dvck here
Revbox ApiV 18,2007