Baird, Baby Girl TOT1N OF QJ8 Z1
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURy, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director CrIL�Gi.,
Name 134. alfd
(72\ r� Case # 35
Date of Cremation (T Cy „r,r 2` , Zb/b
Time Cremation Started SO PH
Time Cremation Completed 2 " JO ill
2
Type of Container ( urAcic.Ard
Remarks :
Mti I; SSI! bt�
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Town of Queensbury
Pine View Cemetery and Crematorium
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
• Authorization to Cremate
The undersigned requests and authorizes Pine View Crematorium,In accordance with and subject to Its Rules and Regulations to
cremate the remains of:
Baby Girl (Baird) Baird F
(Name) (Seat)
4.0 E Broad StreetGlens Falls NY 12801-
(Street) (City) (State) (Zip Code)
who died on day of January 2010
Albany Medical Center Albany NY
at
(Place) (Address)
Name and address of nearest living retetYve or name of person at horsing cremation:
Kadie Marie Baird 40 E Broad Street
(Name) (Address)
Relationship to the deceased M o t h e r
Name d Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge,the deceesedlh 'or(has no)pacemaker,defibrillator,battery,battery peat,power
cen,redlective implant or radioactive device in his or her body.(Circle One)
1 certify that I have fun power end authorization to arrange for the cremation of the remains end 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
savve harmless Pine View Crematorium from any and all claims and demands for lass or damages which may be made against them
by meson of or connected with the cremation of said remains as directed,whether such claims or demands are or are not wholly
Clroundles'ferr_7111.
68 Main Street, Hudson Falls, NY
(Ad•dress)
Broad St. Glens )Falls, NY 12801
(Signature and Address of Relative or Legal Representative)
Signed on this date: /JA1 J7J'�f D
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:.
Mail to
Other arrangements-Please epedfy:
if pulverization of cremated remains is requested,check here XX
Revision:April 18,2007