Doran, Dorothy OF QUEEN,5BU�y
PINE VIEW CEMETERY AIND CREMATORIUM
QUAKER ROAD, QUE,ENSBURY, :v'EW YORK 12804
(518) 745-4476 (518) 745-4477
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Funeral Director
Name Case # pZ
Date or Cremation — .2,c),
Time Cremation Started C (r qC3
Time Cremation Comoleted `j�r '(6
Type c_` Container J�l/7�i��/r/1�� �i1/ y r
Remarks :
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TOWN OF QUEENSBURY �) J
PINE VIEW CEMETERY �!h
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 Regulatio6V�' `to
cremate the remains of:
Margaret Doran Female
(Name) (Sex)
North Ridge Rd. Fort Edward NY 12828
(Street ) (City) (State) ( Zip Code )
who died on _ �r�'=u day of August
at Pleasant Vallen .Infirmary, Argyle, NY
(Place) (Address)
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Name and address of nearest living relative or name of person
authorizing cremation :
Richard Landers 48 Redwood Dr. , Kentfield, CA 94904
(Name) (Address)
Relationship to the deceased son
Name of Funeral Home M. B. Kilmer Funeral Home
IMPORTANT:
I repr to the best of my knowledge, the deceased has or
has o pacemak in his or her body. (Circle One)
I cart ' .'y that I have the full power and authorization tanarraMge
for the cremation of the remains and to direct the dispo;;,,tton of
the cremated remains, that any personal possessions have either
been removed or may be destroyed, and agree to protect,,,Idefend
and save harmless Pine View Crematorium from any and all.-Claims
and demands for loss or damages which may be made agaiinst , Che■ by
reaso-n of or connected with the cremation of said remains as
directed, whether such claims or demands are or are,'�.n'o-t`,whi;aIy
groundless, false or fraudulent.
( >Pn es ) ddress)
IfAfA
(Signature of Relative or Legal Rep. and Address)
Signed on this date : a