Karig, Dorothy Z"O q+N OF QUEEVBU9�Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
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Funeral Director
Name vsG-t Case # 3� j
Date of Cremation Z001
Time Cremation Started t 2 5 (a M
Time Cremation Completed j0: ls Ali,
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Type of Container �CLAJ o,i e c ( rL Sj CASE
Remarks :
M MOVE- 1'!u A M
ib: 00An
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Town of Queensbury
Pine View Cemetery and Cremakidum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Qfthm: (518)745-4476, Crematorium: (518)745-4477 '
Authorization to Cremate
The undersigned requesla and authortaea Pine view Ctemsiorlum,In socordancewkh and stMed to Us Rubs and Regulations to
crerrwe the remains of
Dorothy W. (Kortright) Karig F
(Name) (Sac)
Dean Road Kingsbury NY 12839-
(Stred) rAy) (Swe) (Zip Code)
wAo died on chid 08/09/2009 20_
at Hoosick Falls Health CenterHoosick Falls NY
(Place) (Address)
Nerve and address of nearest living relatYre or named person a3 uMorb"cremation:
Dr. Lyn Karig Hohmannn 159 Whitehall Road
(Name) (Address)
Relationship to tine deceased
Daughter
Name of Funeral Ham Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to tins best of my iarvwladge,the deceased(has)or(Eras no)Pacemaker,detibrilloW,battery,beuary peck,power
cell,radloactive InVft or radioactive device In his or her body.{Clyde One)
I oerWy that I have iut power and audWdZetion to anange for the crematiom d the ierriahs end to dVW the dispoeitlan of the
crarna led ramaina,theft any personal possessions have edam freer ranKwed or maybe destroyed,and agree to protect,defend and
seve hennkrss Pine View C.rsrneloriun from any end all cairns aid demends for bee or damages which may be roads egairmt them
by d or corlrtened wMt tits cremation of said maiskm ass dlnecied,wharf ar such calms or demerrds are or arw not wholly
isles or irau77L
68 Main Street, Hudson Falls, NY
? ( )
159 Whitehall Road, Albany, NY
r
d Rota"or l egai Representable)
Signed on this date:
Disposition of C mffmtad Remains
I hereby dived Pow View Crematorium to dispose of the c maWed remak se follows:
Mail to
Ofhar anangerrerft—Please spediy:
tf pulveftWon of cremaled remains is req nsled,dw&here XX
Revision;April 18,2007