Delair, Margaret J '
Q-UEErA,(
p B`Z1 .
ZIYE VIEW CEMETERY AND
QUAKF'-R ROAD, CREMATORIUM
QUEL'NSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
1 Funeral Director ,,, 1Lt0
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Case N SIU
Date of Cremation
1") ���. �; 71.E
Time Cremation Started
Time Cremation Completed r
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Type of Container Remarks : �Iu}l. 0hs
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Town of Queenshury
Rine Yew Cemetery and Crematorium
21 Quaker Road, Queensbury, Newyork, 12804
Cemetery Office: (518) 745_4476, Crematorium: (518) 745-4477
Authorization to Cremate
The t-ft requests and authorlaes Pine View Gnerorlum,in with end subject to hs Mules and Regulations to
Margaret Sarah (Crawfor i
c Ltc;✓ F
(Name) ( �
Inter-Lakes Re
ib"et) i c orI ash . �a �Fr3
(COY) (State} (ZIp Code)
Vft died on dgyo, 11/29/2009
at Inter-Lakes Health `__- 20
(Address)
Name and address of nearest living relative or name of pawn
aW ..g tatirnatiori:
Mr. Joel DeLair 1 Grace Ave. I-
(Name)
(Address)
Reletlonship ip the depea$ed Son
Name cot Fur al Home Carleton Funeral Home, Inc.
IMPORTANT:
dud to
fiery Peck,Paver
iOOCOire imtite host of my#agwlsdge,the o (has}or(lays no)peoerneker,de�ibn'A W, ►Y.grant ar radec otive device in Iriss orr her her body.(Circle Ones)
i ceWY that I have full power and m Ito have 'either been of�mains and to dW m the drspowiort of the
cremated ems,that an
by re9s r pt)f Ph*View�n fibm UnY and all daims and demands foss or Or may be�myed,grid agree be
protect,defend and
cvrwKK;Wd with the tx MUM of said remains dinect4 y�qw Much or detriandss We or anti Wat
yt�m
less,false or*aud mw.
t68 Main Street, Hudson Falls, NY
(Address)
�l Grace Ave./ / c �/�✓vS I �( y
V(Signaw"me'67WVAMdd*men of rive or Legal Representatpre)
Signed on this date: `y o J 3e)
Disposition of Cremated RwM ttis
I hereby direct Pine View Crematorium to dispose of the CMffW ed remains as*Aov s:.
Wid to
OVW anangementa-Plesee specify:
Npuiverizadon of ommalod remains is requested,dtedc here XX
Arvisiorc April 18,2007