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�CEMlv vty A NOO ' sbvTky. CREMATORIUM
(518) 74
5.4476 NEW YORKZ 8c0.-4L 74S'.4477
Irvneral Director C `�� �
Crematl.on ' Casey 2�3
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Crematlon Completed
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Town of Queerlsbltry
Pine View CemetM and Creffoodum
21 Quaker Road,Queensbury, New York, 12804
Cemetery OWN;e: (518)7454476, Crematorium: (518)745-4477 '
Aud izedw to Cremate
The undersigned requests and aulbodm Pine View Crenalodum,In aocordarroe wth and subied to its Rules and Regulations to
cremme the rerneins of:
Marilyn O'Neil F
(Name) (SOX)
2.7 Woodvale DrivEQueensbury NY 12804-
(shim) (CRY) (State) (zip Code)
who dad on the 7th clay of June mpg
The Pines Glens Falls NY
at
(1319M) ( )
Nerve and address of me as iirirrg rela"or name of person arttrortdng crwrakon:
Reiatlonaltip to the deceased /U�� -
Narm of Funeral Fkn. Carleton Funeral Home, Inc.
IMPORTANT: rQ-¢
I regreaera that to the bed of fny knowledge,the deaeea d(tw)a no P��,dam, ►,�Y Pam.Amer
ee*.radloscdve irriplent or nKkN c*w device in his or her body.( )
i oerWy l va I have U power and audwrizedon to arr wV*for the c rernalon of the ramaft and to dkw the dispoaklon of the
crertand rarrrekrs,that any pereorrel posaaesbrtaere h eifar been removed or maybe desss oyed,and agree to proFecL defend and
woe harmlese Pine View Cramelorlum from arty and all claims and demands for ben or b apes wh1ch may be atado against Own
by reason of or corinamd wklh the asnolore of said rem**as ditecled,whedo such claims or derrterbs are or ere not wholy
wourdes%false *ardulerL .
68 Main Street, Hudson Falls, NY
(Wibtess) _ (Addrem)
(Sk iv and Address of Relative or k egat Representagve)
Signed on thb date: Z 6[a 7
Dbpwkion of Cm mated Remain
I hereby direct Pine Vlew Crematorium to diapaee of ft crerneted remektis ee follows:.
Mall to
OUrer arrangernerm-Plesee WwXy:
tf pulverizetian of a whaled remains m vegtjes1ed,check here XX
P*vWm.ApFV 18,2007