Smith, Isabella B • o�?.iz.aL:f' '..
t_- • •
TOWN OF Q $ 1URY
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Director /v/7 �
Name i-.5/9i.k hI9 6�! 7 / Case #
Date of Crematicn 2
Time Cremation Started Jf !/vr
Time Cremation Completed /O c /9/ iY? �
Type of Container 0/19Jr iedr`s /9s of 7/9 ., 2
Remarks : /, /54)F3
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TOWN OF OUEENSBURY
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:
Isabella B. Smith Female
(Name) (Sex)
131 Walnut St. , Saratoga Springs, NY 12866
(Street ) (City) (State) (Zip Code)
who died on 31st day of August 19 99
at 131 Walnut St. , Saratoga Springs, NY
(Place) (Address)
Name and address of nearest living relative or name of person
authorizing cremation:
Julie C. Smith, 131 Walnut St. , Saratoga Sorinas_, NY 12866
(Name) (Address)
Relationship to the deceased Daughter
Name of Funeral Home William J. Burke & Sons Funeral Home
IMPORTANT:
I represent that to the best of my knowledge, the deceased has or
has no pacemaker in his or a 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 demands for loss or damages which may be made against them by
reason of or connected with the cremation of said remains as
d ' cted, whether such claims or demands are or are not wholly
g o ndless, false fraudulen .
(Witnes ) (Address)
N.-
(Signature of Relative r L gal Rep. and Address)
Signed on this date: q _3 .77 .
i