St. Denis, Adelaide To O
Pl E VIEW Cg u
MFTERY AD CREMATORIUM
ROAD, Q AN
ID
�ISgy, M
(518) 745•4476 iYEw PORK 1�8oa
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�neral Director plat.
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remation Started
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Town of Queensbury
Pirle View Ceffmil ryy and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477 '
Authorization to Cremate
The undersigned requests and authortass Pkne View Craerrotarium,In accordance with end subjsd to ks Rulas and Regulations to
cromete the remains of:
Adelaide Iola (Brooks) St. Denis F
(Name) (Sex)
The Stanton NursiQujeen-ab ab Cent NY 12804-
(St11eet) (City) (Siena) (Zip Code)
whodiedon the 23Rd day of March mpg
at The Stanton Nursing & RehabQu@eantbnry NY
(Plem) (Address)
memo and addrees of no me living mladve or name of pow moxxtft c erne ftL
Mr. John St. Denis 43 Walker Lane
(Name) (Address)
Rbletionghip to the de=wd S o n
Name of Funeral Kne Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the beet of my knowledge,the deceased(has)�paoemalw,cidb Netor,beltuy,bakery peck,mower
cell,radioecdve implant or radioac dve device in his or her body.{
1 oertNy that I have Gil power and eudwrbsrtlon to amwW for the cxemsii a of the remains and to direct the disposition of the
crarnated remains,that any personal poseessi xw have aMwr ineen removed or maybe destroyedv and agree to protest,defend and
save harmless Plne View CremakorWm from wW and aN daM and demands for bee or damages which may be made against them
by reason d or connected wkh the cmernetion of avid rarnains as dkeded,whadw such dale ar denwds are or are not wholly
or or 1RnlckllMt 68 Main Street, Hudson Falls, NY
(Address)
43 Walker Lane
(Signature and Address of Relativoa or Legal Reprecsentative)
Signed on this date:
Dispostion of Cremated Remains
I hereby direct Pine View Cremelork nn to dispose of tiro cremated remains as follows:.
Mail to
other arrangements-Please spe or.
tf puWeaMion of cremated remains is mewled,dredk here XX
Revhko.April 18,2007