Burrall, Margaret PINE Y(EW CEMi TERM A
� R ROAD, CREMATOR M
IU
QVEENSBVRY, NEW YORK 12804
(518) 745.4-476 (518) 745.•4477
FQneral Director
tit t``
�rr� Casein �b3
Crematf.on
Te remation Started
^e : remotion Completed
I �o
Container f
w C�
Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12WX
Cemetery Office: (518)745-4476, Crematorium. (518)745-4477 '
Audxxization to Cremate
The undwWgnted req wft and aullmdZes Pine View OUTOtorlum,in aawdence with and&A*d to Its Rules and Regulations to
cremate the remains d:
Margaret Agnes (McDonnell) F
(Name) (SOO
93 Cedar Queensbury NY 12804
(Sh1w) (city) (scale) (zip Cam)
who died on day d 0 4/14/2 0 0 9 20
at 32 Applehouse Lane Queensbury NY
(13110M) ( )
Now and address of nearest living rebb e or name of person authoAft CRIMO ion:
Peter Burrall 32 Applehouse Lane
(Nance) (Address)
Relatorallp t0 the deceeased S o n
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to fits beet of my latvwiedg%fife deoaased ow)C �oerneker,��bt Y,betlerY per,power
cell,radicecdve irtlQrant or radoact ve device In his or her body.( ne
10W*chat I here Tim power and auamdzaWn to wmntge for the awo 10in d the remakts end to direct the deposition of the
cremated remains,that any peraeufai poseessim s have erlilmm been ramoved or may be deakr0yed,and agree to pi defend and
save hanntbse Pine View art morn arty and all claims and demands for bees or AN ages+Mich may be made against diem
by reason d or cannecied wNh itie c remadon of said ratnakhs as dkecled whedw ouch dainta ar dernands are or ere not wholy
groundbss, or*mxk we
68 Main Street, Hudson Falls, NY
r ) ( )
32 Applehouse `�1th�, QLLee,�zl,,�••y ;N� I t4.�-i
dam`' U�✓L4.L-CVO '
(5yna4av Address of Dive or Legal Represanteuv e)
Signed on this date:
Dispwkion of Cremated Remains
I hereby direct Pinta View Cremaiodurn to dispose of Ute cremated remakrs W follows.
MON ID
other arnantgemerm-Please specify:
tf pulrerizetion of cremated remains is requesled,Ate*here xx
RevWjm April 18,2007