Wendt, Marcelline E TONE VIEW I EESBURY 1 �
PINE EWW CEMETERY 4:: l
A
CREMATORIUM
Quaker Road, Queensbury, New York 12804
Phone (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
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:
Marcelline E. Wendt Female
(Name) (Sex)
PO Box '82, Olmstedville,NY 22857
(Street ) (City) (State) (Zip Code)
•
who died on 3rd day of Dec. 19 96
at GFH, Glens Falls,NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation :
y/1,1//t/ /L , J O a G 4) V ld 7 7
George Wendt, PO- ex 8 2 1 57
(Name) (Address)
Relationship to the deceased SON
Name of Funeral Home Adirondack Cremation Associates,Warrensburg,NY
IMPORTANT:
I represent that to the best of my knowledge, the deceasedIGWEGOI
has no pacemaker in his or her body. (Circle One)
I certify that I have the 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 dem - nds for loss or damages which may be made against them by
r- - .n of or connected with the cremation of said remains as
direc e• , whether such claims or demands are or are not wholly
gr, un• lr - s, false or fraudulent.
_______________
Warrensburg,NY
Wi ness) (Address)
X
Same as above
.tS gnature of Relative or Legal Rep. and Address) .
V12-3-96
Sigr(9'ton this date :