Hammond, Eugene R • TOTIN OF QQ ED9B UR9
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director �i�e � r
Name 5 I p
�u cn� �lw�m�:��{ Case #
Date of Cremation Februc,ri 3 ' 706
Time Cremation Started 1. 0c Ph
Time Cremation Completed
9
Type of Container 7r,rcibi
oard Po*.ier 1941 _a SECavo LASE
Remarks :
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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 gned requests and authorizes Pine View C.matocu st,in accordance with and subject to its Rules and Regulations to
cremate the remains of
Eugene R. Hammond Male
(Name) (sex)
8 Elizabeth St . , Apt. 13O, Whithall , NY
(Street) ( Y) (fie) ( p Code)
who died on 31 day of Jan. 2U-1D
at Home (same as above)
(fie) O
Name and address of nearest living relative or name of person authorizing cremation:
Hazel Hammond, 1464 Rt. 9, Schroon Lake , NY 12870
(Name) (Address)
Relationship to the deceased Spouse
Name of Funeral Home Alexander-Raker FHA Warrensburg, DTY
IMPORTANT:
I represent that to the best of my knowledge,the deceased motrxq(has no)pacemakers dellsinater«arty other battery operated
device in his or her body. (Circle One)
I certify that I have full power and authorization b arrange for the cremation of the remains and to diced the disposition of the
cremated remain that am persory hare eider been removed ermay be destroyed,and agree to protect.defend and
save harmless Pine�V teeQorium t any and alit doh ns and dew for loss or damages which may be made against them
by reason of rtected with of said mambas as dietled.whetter such debits or demands are or me not wholly
or
ensburg, NY
(Witness) ��`� (Address)
X W6Zailxe
Slrx!Address of Relative or Legal Representative)
Signed on Ina date: 2-1-10
Disposition of Cremated Hemalns
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mail to
Other arrangements-Please specify: FH will pick u p
If pulverization of cremated remains is requested,check here X
Revision:Jt ,-2004
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