Sheldrick, Pauline Janet • TOWN OF QUEENSBUYU
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director
Name 'RviJo. )h� crcl� Case # 0
I
Date of Cremation P 1 1 j 2Uj�
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Time Cremation Started I; 2I\ P�
Time Cremation Completed 3. 2Sf1
Type of Container il Loa et-9ewer V t(nNO &/1St
Remarks :
t1 Ptifo r : 3001, itivv6 2; cIQ/1
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:
Mrs. Pauline Janet Sheldrick Female
(Name) (Sex)
8 Elizabeth Street, Whitehall, New York 12887
(Street) (City) • (State) (Zip Code)
who died on 22nd days February 20 10
at 38 Fourth Street, Fair Haven, Vermont 05743
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
Mrs. Paula Genier 38 Fourth Street,Fair Haven, VT 05743
(Name) (Address)
Relationship to the deceased DAUGHTER
Name of Funeral Horne Durfee Funeral I1ome,Fair Haven,VT
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or(has no)pacemaker,defibrillator,battery,battery pack,power
cell,radioactive implant or radioactive device in his or her body.(Circle One)
I certify that I have full power and authorization to arrange for the cremation 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 protect,defend and
save harmless Pine View Crematorium from any and all claims and demands for loss or damages which may be made against them
by reason of or connected with cremation of said remains as directed,whether such claims or demands are or are not wholly
g • Amin.• false or
AiNks
3 '(io.r51„cl\SA-• Nor4 VI t Ie \t N,\ o3t,vei
(Address)
11� Q 38 Fourth Street,Fair Haven,VT 05743
•
IP (Signature and Address of Relative or Legal Representative)
Siignedon this date:
February 23, 2010
Disposition of Cremated Remains
I hereby direct Pine View Crematorium to dispose of the cremated remains as follows:
Mall to
Other arrangements-Please specify: Durfee F. H. will return for remains
If pulverization of cremated remains is requested,check here X X X X X
Revision:January 1,2009