Harrington, Robert D r , ,
�o`wN OF QUEEVBU�Ky
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745-4477
Funeral Directors Y9Rk - /1
Name An 11A)qR';x6L Case #
Date of Cremation
Time Cremation Started 1/11 a,c7 /9! M
Time Cremation Comoleted
Type of Container /dJ9h� ,( X OF
Remarks : -�Z::-1�5--47-
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TOWN OF QUEENSBURY
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:
Robert D. Harrington male
(Name) (Sex)
214 Maple St Glens Falls NY 12801
(Street) (City) (State) (Zip Code)
who died on 1 2tn day of August 2002
at Glens Falls Hospital , Park St. , Glens Falls , NY 12801
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
Mrs Bella Harrington 214 Maple St . , Glens Falls, NY 12801
(Name) (Address)
Relationship to the deceased __ W; fP
Name of Funeral Home carleton Funeral Home, Inc
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, 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,
wheth r such claims or demands are not wholly groundless, false or fraudulent.
Z
Hudson
( � 68 Main St . , Falls NY 12839
(Witness) (Address)
214 Maple St . , Glens Falls, NY 12801
(Signature oflielative or L al Rep. and Address)
Signed on this date: 8/12/02