McDowell, William PIN. YrEw 7 QUEE—rACO
RO emlrrl RY A rD CR AT `,
' Q( Bj N Y
S13UR , EM^TORiU
(518) 745.4476 W YORK 178,
�S1$) 745.4477
+me Fyneral Director
Jill . SrZle
"=a a 0! Cremacl.on Case+ 270
Te ' emation �
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Started 1240
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Tom of Queensbury
P(rw View Cemetery and Cremakwt[tm
21 Quaker Road,Queensbury, New York, 12SO4
Cemetery Office: (518)745.4476, Crematorium: (518)745.4477
Aufix b:jww to Cremate
The undersigned requests and stAwriaes Pine View Crenvm rlum,In accordance with arw subjed to its Rums and Regulations to
cremme the remains d:
William McDowell M
(Name) (Sft)
Bldg 210, Apt. 4,QdbDir Er�pardens h NY 12804-
(SU10) (City) (Sieta) (7J P CCode)
who died on 7 t h day d May 0 9
2t)
at Bldg 210, Apt. 4 Roberts GaQdennsUurtyh NY
(ftm) (Address)
Name and address d 'ON eat living fl*W ra or name of person autttoriritg f/aemallon:
('� ✓✓It� Vy'1✓(0 k)i tile, .. /l�'�+e.}� G'- t's, 67l �tvtf✓�sa "jr by
(Name) (Addrew) _
Rele�to the deceased' t.✓j"
Name d Furmal tkx. Carleton Funeral Home, Inc.
IMPORTANT-
1 repeserrt that to this test of my iaawledge,this deceased(has) sno, ,cladvarillow,tie", y PGK*,P,o.
cell,redioacdve in qft t or radioective device in his or her body.( One
1 oW*Bret 1 have U power and euthorimtbn to arrange for the 0Vm8do0 or the remain and to dWW the dlepoattlon of the
cremated remain,that any personal possessions have slow bean removed or may be destroyed,mid agree to PnAWL defend and
save Plne View Crertnetariurretrom arty and ap daitrrs and derrtartds tlor hsa a damages which may be made 800nst them
Dy resso' a aometxed wNtt the tr�rnetipt d add rornairrs as driecead,rrfrMiner audt doin or demw ds are or ern3 not wholy
false or
(� J 68 Main Street, Hudson Falls, NY
(Signature and Address of Relative or Representative)
Signed or this date.
Disposition of Crerroned Remains
1 hereby dirad Pine View Cmmatoricmt to dispose of the aemated remains as Mowa:
Mail to
Other arrangements-Please spedry:
ff Pulvetwetion of Cremated remarrs is mqueated,check here XX
Revisim..April 18,2007