Watson, Arthur J Sr. S20
Town of Queensbury
/ Pine View Cemetery and Crematorium
/1 21 Quaker Road,Queensbury, New York, 12804
Cemetery Office: (518)745-4476, Crematorium: (518)745-4477
Authorization to Cremate
The wdersigned requests and authorizes Pine View Crematorium,in accorderve with and subject to its Rules and Reputations to
cremate the remains oF.
Arthur J. Watson Sr. Male
(Name) (Sex)
10387 State Route 22 Granville New York 12832
(Street) (may) (State) (Zip Code)
who died on 11 th day of November 20 08
at Glens Falls Hospital Glens Falls New York
(Place) ( )
Name and address of nearest living releWe or name of person authorizing cremetion:
Mrs. Toni Watson 10387 State Route22 Granville New York 12832
(Name) (Address)
Relatior-tship to the deceased Wife
Neme of Funeral Home Jillson Funeral Home Inc.
IMPORTANT:
I represent that to the best of my leowledge,the deceased(has) (has-noTkemalwr.deft0stor,battery,battery pack,power
cell,radioactive Implant or radioactive device in his or her body.
I certify that I have full power and euttrortzation to arrange for the cremation of the remains end to direct the dspoeiton of the
cremated remalro,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 demagets which may be made apektst them
by reason of or corrected with the cremedw of acid remake as directed,whether such claims or demands are or are rot wholly
groundless,false or fraudulent.
(W ) jo 101VMate Route 22
Granville New York 12832
(S "Legal Represarrtative)
Signed on this date: 11 /15/2008
Disposition of Cremated Remains
I hereby direct Pk*View Crematorium to dispose of the cremated remaim as follows:
Mail to
Other arrarrgemerrts-Please specitY: l..J a 1 ;c c�✓r35
If puivertzation of cremated remains is requested,check here
Revision:April 18,2007