Webster, Hope 7+NOF QUEEP�5B U
PLNrE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director ,r
Name
Case k � �(3
Date of Cremation
vent 7�S
Time Cremation Started
Time Cremation Completed
1 '
Type of Container�t �i:l
Remarks ;
AA I
R.
Tom of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477 '
Autfxxlzation to Cremate
The undersigned requests and a dvdass Pkrs View Damstorlurn,In aocordsrroe with and vA*d to ks Rules and Regulations to
cremate the rerneirte af:
Hope Webster F
(Name) (Sea)
278 Lamplighter Acres, Fort Edward, NY
(Street) (City) (State) (Zip Code)
who died on day of 11/14/2009 20_
at Glens Falls Hospital, 100 Park St, Glens Falls,NY
(Plam) (Address)
Name and address of nearest Iivirrg relethre or name of person audXwtmV aennetlon:
Kayla Webster, 278 Lamplighter Acres, Fort Edward, NY
(Name) (Addtm)
Relatforaft to the daCliaged mother
Nam ofFurreralKNI Carleton Funeral Home, Inc.
IMPORTANT:
I repmsew that to the beet of my lawwledge,the deceased ow)
has (has no) maker,deftNador,battery,battery puck,power
ceN,nKNoscdve hllplent ar radoac0ve device in his or her body-
I car*Vat I have U power and suftwh atlon to arrange tar the crerrredon of the remelt and to direct the dispoei<lon of the
cremated remains,that any personal poseseslons have eN a been removed or may be deseryed,and agree to pnAsM defend and
am hanrr m Pine Vlew Crematoriums ftm any and all cteirns and demands for lose or damages wldch may be made ago*them
by mown of a��wkh ft cn rttedm d add romalris as dk eded,whedw such claims or demande are or are not wholly
68 Main Street, Hudson Falls, NY
vv nature Vhd AdcWws of ReletWe or Legal Representative)
signed on this date: NO d
Dispoakion of 0armited Remains
I hereby Bred Pkfe View Crematorium to dispose of the aemated remains as follows:.
Mail to
Other arrangame nts-Pkma specify:
If WIveraetion of Cremated remains is requested,dmck here XX
Revision:April 18,2007