Trello, Mary crncl+N of QUEEVBURY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name
Ni��ti t �PI � Case # 3� 3
Date of Cremation 101, ZO , 7 (Lq
Time Cremation Started 6V �7h
Time Cremation Completed Jd' UU n
Type of Container �,� r�Gi n uEEQ 111?5-r CA5�_;
Remarks :
�f '2S�h
coot i v ; L
Town of Queemsbury
Pine View Cemetery and CremakWum
21 Quaker Road,Qtio msbury, New York, 12844
Cemetery Qfkz: (518)745-4476, Crematorium. (518)745-4477
Autt mization to Cremate
The utdwWgned mquest4 and auttwde s Pkw View Crematorlum,in accordance wkh artd vAjod to ks Rules and Regulations to
cremate the rernairts at
Mary (Campagnone) Trello F
(Name) (Seat)
8.0 Main Street, Apt C Hudson Falls NY 12839-
(813eet) (City) Owe) (7Jp Code)
who died on day d 0 7/14/2 0 0 9 20_
at Glens Falls Hospital Glens Falls NY
( ) ( )
Name and address d neatest livktg relative or name of person+9udxwfzing c ernebm
Mr. Anthony Trello 16 LaClaire Street
(Name) (Address)
Rbiation9hip to the deceased S o n
Norma d Funeral Flatta Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the bast of my lahowledge,the deceased(has)or(has no)pacernsker,deftiNeeor,bdWy,bakery per,power
call,redloactfve impW 1 or nK*)ect ve device In his or her tardy.(Cktde One)
I ow*that I there fiA power and audiorb adon to arrange tar the crernedon of the remalr a and to dWW the disposition of the
cnmv W remolne,that any personal poseesslorn have either heart removed or maybe destroyed,and agree to pnAea defend and
save han v*ws Pine View Creftetorlurh from any and aN dab. and demands for loos or damages which may be made agtttnst!barn
by of a corxhecied wNh the cmmation of add Ietnakts as clInxied,whelfW such dahe or fle P rhda are or are not wholly
false a itawdAern.
��� ���� 68 Main Street, Hudson Falls, NY
(A )
6 LaClaire Strpeludson Falls, NY
( Address of Rely LW&RepresenOlva)
Signed on this cleft:
Dieposkion of Cremated Remakte
I hereby cited Pk*Vlew Crematorium to depose of the cremated remakts as follows:.
Mail to
Ouhet artangetnerrta-Please spedry:
tf pulverization of Cremated remalm is t+egtteal cl,dtedc here XX
Revlski r.April 18,2007