Benoit, Darlene v
OF- QUEE*BUr�y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY NEW Y.ORK 12804
(518) 745-4476 (518) 745-4477
F neral Director
Name W tool Case N uf 3
Date of Cremation o6.r q, 1D�4
Time Cremation Started to �h t
Time Cremation Completed
Type of Container ..J vi fij o*rr LAW
EZ Y C
Remarks ;
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Tom of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queenebury, New York, 12804
Cemetery Office: (518)745-44.78, Crematorium: (518)745-4477
Audwtization to Cremate
The undwWgned requests and a oxxttes Plne View Crematorium,In accordance with and subjed to its Rules and Regulations to
cremate the remains of:
Darlene G. (Grover) Benoit F
(1`isms) (Sax)
4.38 Fortsville Road Moreau NY
(Street) Plly) (State) (ZJp Code)
who died on day of 11/02/2009 20_
Residence Moreau NY
at (Plam) (A )
Name and eddies of nrairest tivinp n1W"Cr name of person autlramrq cremation:
Mr. John Benoit 438 Fortsville Road, Gansevoort,NY
(Name) (Address)
Retatlorehip to the deceased Husband
Carleton Funeral Home, Inc.
Marne of Funeral Hare
IMPORTANT, no) ,�,battery,battery Pack,power
l repreaerrt that to the belt of my tarowledge,the deoesse d(has}
oar,radioactive implant or radioactim device in his or her body.
ire at lust I trove toll power and euthorimtlon to a�for the awnation of the Mtar been removed or maybe destroyed,and ke and to direct the disposition apree prolecL�delend and
to
cremated remake,first any Personal P 's
save ham%"Pine View CroMo xkjm from any and all claims and demands br loos or damages which may be made against!tram
by lesson of or wrxtedad with the cremation of add temairre as directed.whether sudt daims or demands are or arm not wholly
groundless,false or irmrdutent.
68 Main Street, Hudson Falls, NY
` (Address)
s v
Fortsville Road ,
( ' and Address of '' or Le
gal Representative}
Signed an this date:
Disposition of Cremated Remains
I hereby direct Pine view Crematorium to dispose of the cremated remains as Wows'.
Mail to
Other arnwgemerrts-Pleeaa 9pedry=
tf pulm&Wion of cremated remains is requested,check here XX
itevisicn:Apol 18,2007