Hutchins, Ernest Jr. TOrWN OF:. QUEE7�5BUJ�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW Y.ORK 12804
(518) 745-4476 (518) 745-4477
�f Funeral Director_ hiLLEk.
Name �f ft(54 � .4c4'ac Case # I�52
Date of Cremation
Time Cremation Started $. IS
Time Cremation Completed C) 250
Type of Container aloAej
Remarks :
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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)745-4477
Audxxizafion to Cremate
The UnClO signed requests and authorizes Pine View Crematorium.In accordance with and subject to Its Rules and Regulations to
cremate the remains of:
Ernest C. Hutchins,Jr. Male
(fie) (SOX)
Starbuck Road, Indian Lake, NY 12842
(Street) (City) (State) (Zip Code)
who died on 24 day of
October 20 pg
at Glens Falls Hospital,Glens Falls, NY
(Place) VAdress)
Name and address of nearest wing rew&g or nrne of person authorizing cremation:
Karen Hutchins
(Nam) (Address)
Refatiornship to the deceased
Name of Funeral Home Miller Funeral Home
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IMPORTANT:
represent that to the best of my knowledge,the deceased(has)or'lamas noJ�"aiaer,defbri�eEor,be",beftry Peckpowerp
cord,radioactive implant or radioactive device In his or her body.(C k )
1 certify that I have full power and authorbstion to arrange for the cremation of the remains and to direct the disposition of the
cremated remains,that any personal possessions have either been removed or may be destroyed,and agree to protect,defend and
save harmless Pine View Crematorium from any and all dalms and demands for foss or damages wMch may be made against them
by reason of or connected with the cremation of said remains as directed,whether such clams or demands ere or ere not wholly
groundless,false or fraudulent.
(WIMM) (Address)
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(Signettue and Address of Relative or Legal RepreserdatNe)
Signed on this date
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Disposition of Cremated Remains
1 hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mai!to
Other arrangements-Please Specify:
if pctverization of cremated remains Is requested,check here
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Revision:April 18,2DD7
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