McSweeney, Madeline 171�1 q+N OF.- QUEEN5BU-0�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW Y.ORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
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Name --- A �lI( ,H r'icSWWAe� Case #
Date of Cremation
Time Cremation Started
Time Cremation Completed Ib " A n
Type of Container -ve -
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Remarks :
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TOM of Queerlsbury
Pine View Cemetery and Cremaknium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745.4477 '
Audwrizaiion to Cremate
The undersigned req mft and aulhortms Plne View Cremalorlum,In samcdence with and su*a to its Rules and Regulations to
owniate the remains of:
Madeline Barbara McSweeney F
(Nome) (Sex)
7.4 Coleman Avenue Hudson Falls NY 12839-
(Strset) (CRY) (Slate) (Zip Code)
Y*mdledon day of 09/09/2009 20_
at Glens Falls Hospital Glens Falls NY
(Place) (Ad )
Name and address of.oareet I"g rdadve or name of person authoridry aw nedar:
Mrs. Frances Mato 6 Bridle Lane, Hicksville, NY
(Name) (Address)
Reletlortstlip tC tl1e deceased
Sister
Nam of Funeral Horne Carleton Funeral Home, Inc.
IMPORTANT:
l represent that to the beet of rry k nowladg%ft deammed(has)or a no ,deftdieW.batted►,batted+per,poWW
Ceti,radk ecdve implore or raggoac bm devbe in his or her body.(Ckr* )
1 oily that I gave Till power and authodaMon to arrange for ffne cremetion of the ramaft and to dWW the dispoeldon of the
crarnaled remains that any personal poesaesione have eMtar been rarnovad or may be destroyed,and agree to protect,de lend and
save herntlew Pine View Cremalarlum from any and all Balms and dernerds for boa or damages which mey be made sgoirsrt dw n
by reason of or cornneded wllh#w cnffm m of add nemairts as directed.whedeer such dairns ar de---a is are or are not wholly
���false or fisudutsnt.
p 68 Main Street, Hudson Falls, NY
^�4 6 Bridle Lane
(S%Fuw eand Address of Relative or L90 Rep )
Signed an this date. J c-o P� . /y, 00 j
Depaation of creemaeted Retrains
I hereby dnNA Pine View Cmnato kn to dispose of V*aemeted remalm as follows:.
MON 11D
other arrangements-Please mpacWf.
tf pcnlve kWm of cremated remains is requested,dwcic here XX
P4r4lsion:Apn'I 18,2007