Turcotte, Eric Joseph TO 4' L OF Q9UR (
PINE VIEW CEMETERY AND CREMATORIUM
QUAKER ROAD, QUEENSBURY, NEW YORK 12804
(518) 745-4476 (518) 745.4477
Funeral Director
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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:
eric Joseph Turcotte male
(Name) (Sex)
'the—Orchard, Ratite 40. Granvi
(Street) (City) (State) (Zip Code) •
who died on the loth day of December 2004
at The Orchard, Rte 40, Granville, NY 12832
(Place) (Address)
Name and address of nearest living relative or name of person authorizing cremations:
r �i}�Rtt110rk, 12 William St , Hudson Falls , NY 12839
(Name) (Address)
Relationship to the deceased _ friend
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,
whether such claims or demands are not wholly groundless, false of fraudulent.
•
68 Main St , Hudson Falls , NY 12839
(Witness) (Address)
32 William St Hudson Falls, NY 12839
(Signature of Relative or Legal Rep. a d ddre )
1 2/31 /04
Signed on this date: �� G