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Euber, Eugene sr.
TOTIN OF" QUEENSBUR91 PINE VIEW CEMETERY AND CREMATORIUM QUAKER ROAD, QUEENSBURY, NEW YORK 12804 (518) 745-4476 (518) 745-4477 Funeral Director GlANZh -I'v Name / () (y.,F N r 5 Ot3 z 1Z :5 2, Case# p p Go °i Date Of Cremation ,— S- 2Ga(.o Time Cremation Started Tl 2-5 , N. Time Cremation Completed t 1 4-Ai, Type of Container [,1-c2Li I4- C,14 e-1-- M )4 )4 - i Remarks Gti �w co a- 15(4-41 D16-. 1,6t 1 3S441 /0 OaCCIr , Town of Queensbury Pine View Cemetery and Crematorium 21 Quaker Road, Queensbury, New York, 12804 Cemetery Office:(518)745-4476, Crematorium:(518)745-4477 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 Eugene Euber, Sr. M (Name) h ` st S. Glaris }��IS y I S-e I (Street) (may) (State) (Zip Code) /3 / who died on day of 20 l'6 (Place) ( ) Name and address of nearest living relative or name of person authorizing cremation: efJ e E 1 d ,fir �1 Fly S f Sf 77-1- rc1 w e d (Name) (Address) Relationship to the deceased S©/1/41 _ Name d Funeral Home Carleton Funeral Home, Inc. IMPORTANT: I represent that to the best of my knowledge,the deceased(has)or(has no)pacemaker,defibrillator or any other battery operated device in his or her body. (Circle One) I certify that I have 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 deraages which may be made against ham by reason of or contacted with the cremation of said pertains as directed,whether such delves or demands are or are not wholly groin ixl� r/4,1ent 6S- f'/2/q,N S{ 4/50,J F4 f( JVY eNllness) (Address) argnature and Address of R o or Legal Representative) Signed on this date: Disposition of Cremated Remains I hereby direct Pine View Crematorium to dispose of the cremated remains as follows: Mail to Other arrangement'Please specify: - If pulverization of cremated remains Is requested,check here XX Revision:January 1,2006