Bidwell, Elizabeth TC
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`�76 (518) 745'.4477 12soa
Funeral Director
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Town of Queensbury
Pine Yew Cemetery and Crematorium
21 Quaker Road, Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745- 477
Authorization to Cremate
The und"'stned requests and autloriaes Pine View Crematorium,In aaWdanm with and subject to ks Rules and Regulations to
cremate the mains of
Elizabeth Francis (Townsend) Bidwell F
(Name) (SOX)
Route 40 Argyle
NY 12809-
(ShW) (CRY) (State) (Zip Code)
whodiedon The 2nd ofJune 09
20_
at Glens Falls Hospital Glens Falls NY
(Place) (address)
Name and address of nearest living relative or name of person auttroriang crwm k n:
William Townsend 78 Townsend Road
(Name) (Address)
Rt'iation9l to the deed Nephew
Name of Funeral Nome Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of MY kVNAedQe,the deceased jfik*br{has no)pacenmker,deftwIlatar,battery,battery padc,power
cell.radioactive implant or radioactive device in his or her body.(Chile One)
I certify that I have fill power and aulhorimtlon to arrange for the cxemeedOn of the remains and to dWw the ft)ositlon of the
cremated remains,dot any personal poesassiats have either been removed or may be destroyed,and agree to Protect defend and
save harmless Pine View Cresnetaknn from any and aN dak, artd demands for loss or damages whtich may be made against them
by nsasor►offonnected with the cremation of said rernelns as dk ected,WhOdw audit deb t8 or dwrrands are or Sm not wholly
or Irsudukent.
S, 68 Main Street, Hudson Falls, NY
(o send Road, Hartford, NY
Heron/:arxt ofR�$tative or Legal Representative)
Signed on this date: `t! _ (�v-' 9
Disposition of a errtated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as*Mows
LUA 1D
Other arrangements-Planes apathy:
if p*mwahon of a mabd remains is requested,dreck here XX
pevisi m April 18,2W?