DePalo, Patrick 2"O O .
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RO^p �TERY I�NU CREMATORIUM�' `J
5,4476 �Y' "W YORK 17ON
(518) 7a5•a�76 (S18) 745*.4477
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Totem of Quewvftry
Firm View CemeWy and Cromatortum
21 Quaker Road,Queensbury, New York, 12WK
Cemetery ow. (518)7454476,Crematorium:(518)745-4477
Autttawiz bon as Cremate
The undersigned rm"mb and&A urtos Phe View Owndwkn,In aom*noe with and to Its Rubs and Regubtiorsr to
cxem"the maw**af:
Patrick N. DePalo Male
(Name) (Sao
97 Feeder St . , Hudson Falls , NY 12839
(Street) (CRY) (State) (ZIP Cade)
wtro died on 2 0 t h ft of May 2009
Glens Falls hospital, Glens falls, NY
(ftm) (address)
Name and address of neamat iivirrg r> re qr Herres of parssan enatlsarirtp caereatiarr,
Constance DePalo, 97 Feeder St. , Hudson Falls, NY
(Name) (Adtess)
RWOOMKO to the docomed wife
Nam dFurwngHam Carleton Funeral Home, Inc.
IMPORTANT:
I rmp owo that to thv best of ow Wwwk0p,ft docoesed tw)or fm no)pacemaker,do ter,battery,btetary Peck.power
+dell,rmdwc&m Wnp*t or rarsoecdve device In hie or her body.(Ckde One)
I ow"that i tans U powo and mxhodnft r w arrange tar the ovine k n of the rerrs km wW to dWW the fspoeslon of rim
cxemmod remains,that=V peso poommlons twee sores been removed or may be destroyed,and agree to prated.defend and
seas hsmtlesa Plne View CraneeWdm from trry and aN tiaierrs=W demands tar fm or domops wlidt may be am*agiah own
by mmo d or corrected wkh t o m motion of add immita as+dn xA4 whedrer such cbebtts or dommft sm or era not who#y
�c-r �_• Carleton__Funeral Home, Inc.
{YYitness) � (Address)
97 Feeder St
I �(�mV of ortoW� ) NY 12839
Signed on this dace: May 2 0, 2 0 0 9
DWposkion of Ccarrrated Rerrreirw
I hereby diced Pk*View C remakwium to dispose of the cremated mmm*s as toNows:.
h+d to
Odw arrolowrsm-Ph""epoxy.
If Ix"rized n d d rem Is reed,check here
Revisor April 19,2007