Griffin, John ..uY.iiaaL_f. ........... •
2�0W V OF QQ1BQ1R1Y
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director agKE:
Name V�� /7/`L (�' � �(/C Case # „1". Zp2
Date of Crematicn i
---- "153)
Time Cremation Started '/ Vc-
aa
i
Time Cremation Completed /2 (1/, l
Type of Container 6- 11.6 /l
Remarks :
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TOWN OF [iUEENSBURY /;j45.7.
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PINE VIEW CEMETERY
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:
John M. Griffin Male
(Name) (Sex)
A6 Trotterview, Saratoga Springs . NY 17RF,
(Street) (City) (State) (Zip Code)
who died on 791-h day of November 19 qR
at Saratoga Hospital, Saratoga Springs . NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Mar ret Kilr�ara Ati rr^ttexu'
Sarato'' ings. I�TY
(Name) (Address)
Relationship to the deceased Daughter
Name of Funeral Home William J. Burke & Sons
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 ersonaldirect the possessionsshavetion of
either
the cremated remains, that any p
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 the cremation of said remains as
directed, whether such claims or demands are or are not wholly
• roundless, fa r; fraudulent.
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(Witness)
(Address) 4
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1 (Sid ature of Felative Legal Rep. and Addr ss)
Signed on this date : Li ( -