Nolin (Bordeau) Elaine Vesta •
•
LO O
PINEVIEW � EES�
CEMETERY AND CREMA r�J
QUAKER ROAD, QVEENSBURy TORTUM
(518) 745-4476 ' NEW YORK tz804
(518) 745.-4477
Funeral
Director ar
Fame C
Date Of � case#
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Cremation ----�
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Time Cremation
Started
Cremation Completed
Type of Container Ctri Latr
Remarks uwr� 4k Ise
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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 Regulation to
cremate the remains of:
Elaine Vesta (Bordeau) Nolin F
(Name) (Sax)
4.6 Egan Road Queensbury NY 12804-
(Street) (City) (State) (Zip Code)
etc died on 30th day August 08
20_
Glens Falls Hospital Glens Falls NY
at
( ►) (Address)
Name and address of nearest living relative or name of person authorizing cremation:
R. Gary Nolin 46 Egan Road, Queensbury, NY 12804
(Name) (Address)
Relationship to the deceased Husband
•
Name of Funeral Home Carleton Funeral Home, Inc.
IMPORTANT:
I represent that to the best of my knowledge,the deceased(has)or(has no)pecker,defibrillator,battery,battery pack,power
cell,redioac eve implant or radioactive device in his or her body.(Circe One)
1 certify that I have full power and authorization to arrange for the aremetion of the remaths and to direct the cespoeitton of the
cremated remains,that any personal poeeaesions have either been removed or may be destroyed,and agree to ixdect.defend and
save harmless Pine View Crematorium from any and all claims and demands for lase or damages which may be made against them
by reesas or or catnecsed the cremation of said remains as directed,whether such claims or demands are or are not wholly
or
i► /\ sin Street, Hudson Falls, NY
v Ghs�2 ‘ ) (Address)
46 Egan Rd. , Queensbury, NY
(Signature end Address of Relative or Legal Representative)
Signed on this date: Au a 3 9, 2008
Disposition of Cremated Remains
1 hereby direct Pine View Crematorium to dispose of the cremated remains es follows:.
Mail to
Other arrangements,Please
if pkdvedzation of cremated remains is requested,crack here XX
Revision:April 18,2007