Watkins, Joan TOT1N OF QjBU '
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director 1 �
Name ;j�r WSf �/Ns
Case #
Date of Cremation 1+ 14, jZ i 7Ojb
Time Cremation Started SO vi '/
Time Cremation Completed IO = SS /1d�
Type of Container `«ibaaiGr Cl21 knoFP
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Remarks :
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Town of Queensbury
Pine View Cemetery and Crematottum
21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4470, 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:
Joan Watkins F
(Name) (Seoc)
1.0 Minor Street Hudson Falls NY 12839-
(Street) (City) (State) (Zip Code)
who died on day of 0 2/0 5/2 010 20_
Residence Hudson Falls NY
at
( ) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Myron Watkins 10 Minor Street, Hudson Falls,NY
(Name) (Address)
Relationship to the deceased Husband
Name d Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or no pacemaker,defibrillator,battery,battery peck,power
cell,radioactive implant or radioactive device in his or her body.( )
1 certify that I have full power and authorization to arrange for the aemeNgn 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 pnxect,defend and
save harmless Pine View CrernetOri im from any and all Bairns and demands for foes or damages which may be made against them
by meson of or competedwith the cremation of said remains as directed,whether such dales or demands are or are not wholly
68 Main Street, Hudson Falls, NY
(Witness) 6. G (Address)
A Minor Sheet, Hudson Falls, NY
and Address of Relative or Legal Representative)
Signed on this date: February 5, 2010
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the aemated remakes as follows:.
Mail to
Other arrangements•Please specify:
if pulverization of cremated rancheros is requested,check here XX
ROVlslon April 18,2007