Hill, Janet rrO O ,
PINE Y[EW CS
QUEEgq"5TU'r�_7
MFTERY ^ND CREM ,,,TOR,U
�hX�R ROAD. QIrEL'NSg��. M
(518) 745•4476 NEW YOR}C iz804
(518) 745'•4.477
Funeral Director
Fame J��nQI
Cases+Cremwon
,� I
Te Cremation
Started
Cremation Completed
Container / MCI
Town of Queensi urY
Pine Yew Cemetery 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&AWIbes Pine View C"W eforium.in aac+ordarm with and subject to Its Rules and Regulations to
cYemate the remains of:
Janet (Hill) Hill F
(blame) (Sex)
5.025 Main Street Corinth NY 12822-
(Street) (City) (State) (ZJp Code)
who died on
loth day of March 2009
at Glens Falls Hospital Glens Falls NY
(per) (Address)
Name and address of neweat living Mtativ'e or Warne of person auttrori*hg cremation:
Kim Tutt 36 East Street, Amityville, NY
(Name) (Address)
Relationel*to the deoeased Niece
Carleton Funeral Home, Inc.
Name d Funeral Morrie
IMPORTANT:E refxeserrt that to the beat of my lagwledge,the deceased(tras)or(has no)paeenmerk ,defbrM*W,battery,battery pec(,power
ceil,radioactive impbw t or radioactive device in his or her body.(Ckde One)
1 cer*that I have full power and suawrbation to arrange for the cremetim of the rw wft and to direct the drspoeeien of to end and
cremated remairm,that any personal poesessions have either been removed or may be destroyed,and agree�en eland
save hertnless PMe View Cremebmiu r from any end all claims and demands for kne or damages MMich may
by of or connected with Ore cremation of said m m m as dirwied,whedW such dainre or deffOXIs are or are not WhORY
,false Or 1fWaLikileM
68 Main Street, Hudson Falls, NY
fffllness) ityv
36 East Street Amityville, NY
(Sigruftm and Address of Relative or Legal Representative)
Signed on this date:
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as fdows:.
Mail to
Other arrangernems'Pieese y'
If V Werbation of cremated mmair>,s is requested,dv*here XX
Revision;April 18,2007