Joslin, Pauline Elizabeth TOWN OF QUEENSBURY
PINE VIEW CEMETERY
CREMATORIUM �Q
Quaker Road, Queensbury, New York 12804 ((��
Phon (518) Crematorium 745-4477 or if no answer
Cemetery 745-4476
AUTHORIZATION TO CREMATE
The undersigred requests and authorizes Pine View Crematorium , : n
accordance pith and subject to its Rules and Regulations to
cremate the remains' of:
Pauline Elizabeth Joslin Female
(Name) (Sex)
Stanton Rd. Lake George New York 12845
(Street (City ) (State ) ( Zip Code )
who died on _ 9th day of December
1996
at Glens Falls Hospital Glens Falls, New York
(Place) (Address) •
Name and address of nearest living relative or name of person
authorizing cremation :
Allen E. Joslin P.O. Box 472 Fort Ann, New York 12827
(Name) (Address)
Relationship to the deceased son
Name of Funeral Home Alexander-Baker Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or
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 , defenc
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 the cremation of said remains as
directed, whether such claims or demands are or are not wnoliy
groundl , false or fraudulent .
(Witne sr (Address)
SignatL -e of Rel ive Jor Legal Rep. and Address )
Signed on thi date : jc2j9/76
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